Title

Increased female political representation associated with lower county-level uninsured and preventable hospitalizations rates in the US, 2013-2018

Document Type

Article

Publication Date

3-2023

Journal / Book Title

Public Health

Abstract

Although women comprise 50% of the population, females remain underrepresented in government. Inequitable female political representation, a form of structural sexism, may impact population health. Previous studies focused primarily on individual health behaviors and low- or middle-income countries. To date, no study has examined the association between female political representation and healthcare access and utilization, immediately policy-amenable outcomes, in the United States.

Study design

This was a repeated cross-sectional study.

Methods

This study uses 2013–2018 county-level data from the County Rankings. I performed multilevel analyses to determine the relationships between state-level female representation (% female state legislators) and two outcomes—the percentage of county-level population under age 65 years without health insurance (primary outcome) and the county-level preventable hospitalization rates (secondary outcome of interest). Potential confounders included county-level and state-level characteristics such as the unemployment rate. I also examined whether associations differed by political party control of the state legislature.

Results

In the fully adjusted model, one standard deviation difference in female political representation was associated with a decrease of 0.22 percentage points in county-level uninsured (95% confidence interval = −0.32, −0.12). The association between female political representation and preventable hospitalization rate differed according to state political party in control, with a decrease found only among counties in democratic/split controlled states (−80.51, 95% confidence interval = −149.65, −11.38).

Conclusions

The results suggest that policy intervention addressing the underrepresentation of women in government may help increase the proportion of uninsured and, under certain circumstances, decrease county-level unnecessary hospitalizations. However, further research is needed to better understand the role of political party control in modifying noted associations.

DOI

https://doi.org/10.1016/j.puhe.2022.12.007

Published Citation

Liu, SY. Increased female political representation associated with lower county-level uninsured and preventable hospitalizations rates in the United States, 2013–2018. Public Health 2023: 26:7-12.

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