Social
Health status and voting participation among US citizens Jordan Baeker Bispo* Jordan Baeker Bispo Jingyi Tian Ahmedin Jemal Farhad Islami
Background: Increasing voter participation was recently added as a core objective of Healthy People 2030. In addition to structural barriers, poor health and chronic disease burden may hinder civic engagement, but few studies have examined this relationship at the national level. This study examines associations between health status and voting among US citizens, overall and by age, sex and race/ethnicity.
Methods: Data are from the 2023 National Health Interview Survey. The dependent variable was self-reported voting participation (yes/no) in the most recent local election. Health indicators included overall self-rated health (SRH), disability status (yes/no), and history (ever diagnosed: yes/no) of five common chronic diseases (heart disease, stroke, cancer, chronic obstructive pulmonary disease [COPD], and diabetes). Associations were modeled using survey-weighted logistic regression with adjustment for respondent sociodemographic characteristics.
Results: Data from more than 25,000 respondents were analyzed. Overall, the prevalence of voting was significantly lower for those with fair/poor versus excellent/very good SRH (adjusted prevalence ratio [aPR]=0.87, 95%CI=0.83-0.90), and for those with a disability (aPR=0.87, 95%CI=0.83-0.91) or history of stroke (aPR=0.89, 95%CI=0.83-0.95), heart disease (aPR=0.95, 95%CI=0.91-0.99) or COPD (aPR=0.91, 95%CI=0.86-0.97) than those without. Conversely, cancer history was associated with higher voting participation (aPR=1.06, 95%CI=1.03-1.11). In stratified analyses, associations were similar for males and females. Associations with SRH, COPD, diabetes and stroke were stronger among NH White respondents, and associations with cancer were stronger at younger ages.
Conclusions: Poor overall health and chronic disease history, with the exception of cancer, were linked to lower voting participation. Efforts are needed to expand voting accessibility among adults with health-related barriers to civic engagement.