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American Journal of Public Health logoLink to American Journal of Public Health
. 2001 Jan;91(1):99–104. doi: 10.2105/ajph.91.1.99

Socioeconomic inequality in voting participation and self-rated health.

T A Blakely 1, B P Kennedy 1, I Kawachi 1
PMCID: PMC1446487  PMID: 11189832

Abstract

OBJECTIVES: This study tested the hypothesis that disparities in political participation across socioeconomic status affect health. Specifically, the association of voting inequality at the state level with individual self-rated health was examined. METHODS: A multilevel study of 279,066 respondents to the Current Population Survey (CPS) was conducted. State-level inequality in voting turnout by socioeconomic status (family income and educational attainment) was derived from November CPS data for 1990, 1992, 1994, and 1996. RESULTS: Individuals living in the states with the highest voting inequality had an odds ratio of fair/poor self-rated health of 1.43 (95% confidence interval [CI] = 1.22, 1.68) compared with individuals living in the states with the lowest voting inequality. This odds ratio decreased to 1.34 (95% CI = 1.14, 1.56) when state income inequality was added and to 1.27 (95% CI = 1.10, 1.45) when state median income was included. The deleterious effect of low individual household income on self-rated health was most pronounced among states with the greatest voting and income inequality. CONCLUSIONS: Socioeconomic inequality in political participation (as measured by voter turnout) is associated with poor self-rated health, independently of both income inequality and state median household income.

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Selected References

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  1. Backlund E., Sorlie P. D., Johnson N. J. The shape of the relationship between income and mortality in the United States. Evidence from the National Longitudinal Mortality Study. Ann Epidemiol. 1996 Jan;6(1):12–22. doi: 10.1016/1047-2797(95)00090-9. [DOI] [PubMed] [Google Scholar]
  2. Blakely T. A., Kennedy B. P., Glass R., Kawachi I. What is the lag time between income inequality and health status? J Epidemiol Community Health. 2000 Apr;54(4):318–319. doi: 10.1136/jech.54.4.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blakely T. A., Woodward A. J. Ecological effects in multi-level studies. J Epidemiol Community Health. 2000 May;54(5):367–374. doi: 10.1136/jech.54.5.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Daly M. C., Duncan G. J., Kaplan G. A., Lynch J. W. Macro-to-micro links in the relation between income inequality and mortality. Milbank Q. 1998;76(3):315-39, 303-4. doi: 10.1111/1468-0009.00094. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fiscella K., Franks P. Poverty or income inequality as predictor of mortality: longitudinal cohort study. BMJ. 1997 Jun 14;314(7096):1724–1727. doi: 10.1136/bmj.314.7096.1724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Idler E. L., Kasl S. V. Self-ratings of health: do they also predict change in functional ability? J Gerontol B Psychol Sci Soc Sci. 1995 Nov;50(6):S344–S353. doi: 10.1093/geronb/50b.6.s344. [DOI] [PubMed] [Google Scholar]
  7. Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. doi: 10.1136/bmj.312.7037.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kawachi I., Kennedy B. P., Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999 Aug;89(8):1187–1193. doi: 10.2105/ajph.89.8.1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kawachi I., Kennedy B. P., Gupta V., Prothrow-Stith D. Women's status and the health of women and men: a view from the States. Soc Sci Med. 1999 Jan;48(1):21–32. doi: 10.1016/s0277-9536(98)00286-x. [DOI] [PubMed] [Google Scholar]
  10. Kawachi I., Kennedy B. P. Health and social cohesion: why care about income inequality? BMJ. 1997 Apr 5;314(7086):1037–1040. doi: 10.1136/bmj.314.7086.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kawachi I., Kennedy B. P. Income inequality and health: pathways and mechanisms. Health Serv Res. 1999 Apr;34(1 Pt 2):215–227. [PMC free article] [PubMed] [Google Scholar]
  12. Kawachi I., Kennedy B. P., Lochner K., Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health. 1997 Sep;87(9):1491–1498. doi: 10.2105/ajph.87.9.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kawachi I., Kennedy B. P. The relationship of income inequality to mortality: does the choice of indicator matter? Soc Sci Med. 1997 Oct;45(7):1121–1127. doi: 10.1016/s0277-9536(97)00044-0. [DOI] [PubMed] [Google Scholar]
  14. Kennedy B. P., Kawachi I., Glass R., Prothrow-Stith D. Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ. 1998 Oct 3;317(7163):917–921. doi: 10.1136/bmj.317.7163.917. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kennedy B. P., Kawachi I., Prothrow-Stith D. Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ. 1996 Apr 20;312(7037):1004–1007. doi: 10.1136/bmj.312.7037.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lemeshow S., Letenneur L., Dartigues J. F., Lafont S., Orgogozo J. M., Commenges D. Illustration of analysis taking into account complex survey considerations: the association between wine consumption and dementia in the PAQUID study. Personnes Ages Quid. Am J Epidemiol. 1998 Aug 1;148(3):298–306. doi: 10.1093/oxfordjournals.aje.a009639. [DOI] [PubMed] [Google Scholar]
  17. Lochner K., Kawachi I., Kennedy B. P. Social capital: a guide to its measurement. Health Place. 1999 Dec;5(4):259–270. doi: 10.1016/s1353-8292(99)00016-7. [DOI] [PubMed] [Google Scholar]
  18. Lynch J. W., Kaplan G. A., Pamuk E. R., Cohen R. D., Heck K. E., Balfour J. L., Yen I. H. Income inequality and mortality in metropolitan areas of the United States. Am J Public Health. 1998 Jul;88(7):1074–1080. doi: 10.2105/ajph.88.7.1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Mackenbach J. P., Kunst A. E. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997 Mar;44(6):757–771. doi: 10.1016/s0277-9536(96)00073-1. [DOI] [PubMed] [Google Scholar]
  20. Sapolsky R. M., Alberts S. C., Altmann J. Hypercortisolism associated with social subordinance or social isolation among wild baboons. Arch Gen Psychiatry. 1997 Dec;54(12):1137–1143. doi: 10.1001/archpsyc.1997.01830240097014. [DOI] [PubMed] [Google Scholar]
  21. Soobader M. J., LeClere F. B. Aggregation and the measurement of income inequality: effects on morbidity. Soc Sci Med. 1999 Mar;48(6):733–744. doi: 10.1016/s0277-9536(98)00401-8. [DOI] [PubMed] [Google Scholar]

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