Electoral Democracy and Working-Age Mortality.
Electoral Democracy and Working-Age Mortality.
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选举民主和劳动年龄死亡率。
DOI：
10.1111/1468-0009.12658
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Grumbach,JacobM
中科院分区：
文献类型：
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作者：
Montez,JenniferKaras;Cheng,KentJason;Grumbach,JacobM
政策要点近几十年来，美国选举民主的侵蚀可能是导致工作年龄死亡率居高不下并不断上升的原因，这种情况早在COVID-19大流行之前就出现了。美国各州选举民主的侵蚀与凶杀、自杀，特别是药物中毒和传染病导致的工作年龄死亡率上升有关。州和联邦为加强选举民主所做的努力，例如禁止党派不公正划分选区、改善选民选举权和改革竞选财务法，可能会避免每年成千上万的工作年龄成年人死亡。背景美国的工作年龄死亡率很高，而且还在上升，这是一个令人担忧的事实，早在COVID-19大流行之前就已经存在。尽管人们对高失业率和不断上升的失业率提出了几个假设，但民主侵蚀的潜在作用却被忽视了。本研究探讨了选举民主和工作年龄死亡率之间的关联，并评估了经济，行为和社会因素如何可能导致它。方法我们使用了国家民主指数（SDI），每个州的选举民主的年度总结从2000年到2018年。我们将SDI与每个州25-64岁成年人的年年龄调整死亡率合并。模型估计了SDI与各州工作年龄死亡率（所有原因和六个特定原因）之间的关联，调整了政党控制，安全网慷慨度，工会覆盖率，移民人口和各州的稳定特征。我们评估了经济（收入，失业），行为（饮酒、睡眠）和社交（婚姻、暴力犯罪、监禁）因素占的协会。发现增加选举民主的国家从中等水平（定义为空间数据基础设施分布的第三个五分位数）第五个五分位数（定义为第五个五分位数）与下一年工作年龄男性和女性的死亡率分别降低3.2%和2.7%相关。从SDI分布的第三到第五个五分位数的所有州增加选举民主可能导致2019年工作年龄死亡人数减少20，408人。民主与死亡率的关联主要反映了社会因素，在较小程度上反映了健康行为。在一个国家的选举民主的增加大多是强烈相关的药物中毒和传染病的死亡率较低，其次是减少凶杀和suictions.ConclusionsErosion的选举民主是一个威胁到人口健康。这项研究增加了越来越多的证据表明，选举民主和人口健康是密不可分的。
Policy PointsThe erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working‐age mortality rates, which predate the COVID‐19 pandemic.Eroding electoral democracy in a US state was associated with higher working‐age mortality from homicide, suicide, and especially from drug poisoning and infectious disease.State and federal efforts to strengthen electoral democracy, such as banning partisan gerrymandering, improving voter enfranchisement, and reforming campaign finance laws, could potentially avert thousands of deaths each year among working‐age adults.ContextWorking‐age mortality rates are high and rising in the United States, an alarming fact that predates the COVID‐19 pandemic. Although several reasons for the high and rising rates have been hypothesized, the potential role of democratic erosion has been overlooked. This study examined the association between electoral democracy and working‐age mortality and assessed how economic, behavioral, and social factors may have contributed to it.MethodsWe used the State Democracy Index (SDI), an annual summary of each state's electoral democracy from 2000 to 2018. We merged the SDI with annual age‐adjusted mortality rates for adults 25–64 years in each state. Models estimated the association between the SDI and working‐age mortality (from all causes and six specific causes) within states, adjusting for political party control, safety net generosity, union coverage, immigrant population, and stable characteristics of states. We assessed whether economic (income, unemployment), behavioral (alcohol consumption, sleep), and social (marriage, violent crime, incarceration) factors accounted for the association.FindingsIncreasing electoral democracy in a state from a moderate level (defined as the third quintile of the SDI distribution) to a high level (defined as the fifth quintile) was associated with an estimated 3.2% and 2.7% lower mortality rate among working‐age men and women, respectively, over the next year. Increasing electoral democracy in all states from the third to the fifth quintile of the SDI distribution may have resulted in 20,408 fewer working‐age deaths in 2019. The democracy–mortality association mainly reflected social factors and, to a lesser extent, health behaviors. Increasing electoral democracy in a state was mostly strongly associated with lower mortality from drug poisoning and infectious diseases, followed by reductions in homicide and suicide.ConclusionsErosion of electoral democracy is a threat to population health. This study adds to growing evidence that electoral democracy and population health are inextricably linked.