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Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study
BACKGROUND: Many states in the United States (US) have introduced barriers to impede voting among individuals from socio-economically disadvantaged groups. This may reduce representation thereby decreasing access to lifesaving goods, such as health insurance. METHODS: We used cross-sectional data fr...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904135/ https://www.ncbi.nlm.nih.gov/pubmed/36779033 http://dx.doi.org/10.1016/j.lana.2021.100026 |
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author | Pabayo, Roman Liu, Sze Yan Grinshteyn, Erin Cook, Daniel M. Muennig, Peter |
author_facet | Pabayo, Roman Liu, Sze Yan Grinshteyn, Erin Cook, Daniel M. Muennig, Peter |
author_sort | Pabayo, Roman |
collection | PubMed |
description | BACKGROUND: Many states in the United States (US) have introduced barriers to impede voting among individuals from socio-economically disadvantaged groups. This may reduce representation thereby decreasing access to lifesaving goods, such as health insurance. METHODS: We used cross-sectional data from 242,727 adults in the 50 states and District of Columbia participating in the US 2017 Behavioral Risk Factor Surveillance System (BRFSS). To quantify access to voting, the Cost of Voting Index (COVI), a global measure of barriers to voting within a state during a US election was used. Multilevel modeling was used to determine whether barriers to voting were associated with health insurance status after adjusting for individual- and state-level covariates. Analyses were stratified by racial/ethnic identity, household income, and age group. FINDINGS: A one standard deviation (SD) increase in COVI score was associated with an overall increased odds of being uninsured (OR=1.25; 95% CI=1.22, 1.28). This association was also present for Non-Hispanic Black (OR=1.18; 95% CI=1.13,1.22), Hispanic (1.18; 95% CI=1.15,1.21), and Asian (OR=1.45;95%CI=1.27,1.66), and other Non-Hispanic (OR=1.12, 95% CI=1.06, 1.18) US adults, but not for White Non-Hispanic and Native US adults. Likewise, a one SD increase in COVI among adults from low-income households was associated with an increased odds of being uninsured (OR=1.32; 95% CI=1.26,1.38) but there was no association among individuals with incomes greater than $75,000. This association was similar for younger US adults (OR=1.22; 95%CI=1.20,1.24) but not among those aged 45 to 64. INTERPRETATION: Groups commonly targeted by voting restriction laws—those with low incomes, who are racial minorities, and who are young—are also less likely to be insured in states with more voting restrictions. However, those who are wealthier, white or older are no more likely to be uninsured irrespective of the level of voting restrictions. FUNDING: Pabayo is a Tier II Canada Research Chair. |
format | Online Article Text |
id | pubmed-9904135 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-99041352023-02-10 Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study Pabayo, Roman Liu, Sze Yan Grinshteyn, Erin Cook, Daniel M. Muennig, Peter Lancet Reg Health Am Research Paper BACKGROUND: Many states in the United States (US) have introduced barriers to impede voting among individuals from socio-economically disadvantaged groups. This may reduce representation thereby decreasing access to lifesaving goods, such as health insurance. METHODS: We used cross-sectional data from 242,727 adults in the 50 states and District of Columbia participating in the US 2017 Behavioral Risk Factor Surveillance System (BRFSS). To quantify access to voting, the Cost of Voting Index (COVI), a global measure of barriers to voting within a state during a US election was used. Multilevel modeling was used to determine whether barriers to voting were associated with health insurance status after adjusting for individual- and state-level covariates. Analyses were stratified by racial/ethnic identity, household income, and age group. FINDINGS: A one standard deviation (SD) increase in COVI score was associated with an overall increased odds of being uninsured (OR=1.25; 95% CI=1.22, 1.28). This association was also present for Non-Hispanic Black (OR=1.18; 95% CI=1.13,1.22), Hispanic (1.18; 95% CI=1.15,1.21), and Asian (OR=1.45;95%CI=1.27,1.66), and other Non-Hispanic (OR=1.12, 95% CI=1.06, 1.18) US adults, but not for White Non-Hispanic and Native US adults. Likewise, a one SD increase in COVI among adults from low-income households was associated with an increased odds of being uninsured (OR=1.32; 95% CI=1.26,1.38) but there was no association among individuals with incomes greater than $75,000. This association was similar for younger US adults (OR=1.22; 95%CI=1.20,1.24) but not among those aged 45 to 64. INTERPRETATION: Groups commonly targeted by voting restriction laws—those with low incomes, who are racial minorities, and who are young—are also less likely to be insured in states with more voting restrictions. However, those who are wealthier, white or older are no more likely to be uninsured irrespective of the level of voting restrictions. FUNDING: Pabayo is a Tier II Canada Research Chair. Elsevier 2021-07-30 /pmc/articles/PMC9904135/ /pubmed/36779033 http://dx.doi.org/10.1016/j.lana.2021.100026 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research Paper Pabayo, Roman Liu, Sze Yan Grinshteyn, Erin Cook, Daniel M. Muennig, Peter Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title | Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title_full | Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title_fullStr | Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title_full_unstemmed | Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title_short | Barriers to Voting and Access to Health Insurance Among US Adults: A Cross-Sectional Study |
title_sort | barriers to voting and access to health insurance among us adults: a cross-sectional study |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904135/ https://www.ncbi.nlm.nih.gov/pubmed/36779033 http://dx.doi.org/10.1016/j.lana.2021.100026 |
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