Socioeconomic inequality in voting participation and self-rated health

Objectives. This study tested the hypothesis that disparities in political participation across socioeconomic status affect health. Specifically the a ssociation of voting inequality at the state level with individual self-rat ed health was examined. Methods. A multilevel study of 279 066 respondents to the Current Populatio n Survey (CPS) was conducted. State-level inequality in voting turnout by s ocioeconomic 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 inequalit y 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 wi th 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 lo w individual household income on self-rated health was most pronounced amon g states with die greatest voting and income inequality. Conclusions. Socioeconomic inequality in political participation (as measur ed by voter turnout) is associated with poor self-rated health, independent ly of both income inequality and state median household income.