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Table 1 Articles identified that examine voting, health, and interventions in healthcare settings

From: Voting, health and interventions in healthcare settings: a scoping review

Authors (year)Geographic locationTopic areaMain findingsMeasuresConfounders addressed
Albright et al. (2016) [12]Colorado, USAAssociation between health and votingNegative association between health risk behavior (smoking) and voting in the national US election
Daily smokers were 60% less likely to vote than nonsmokers (OR: 0.38, 95% CI: 0.27% to 0.54%).
Self-reported smoking status; self-reported voting in the 2004 national US electionSex, age, race/ethnicity, education, employment status, marital status, household income relative to the federal poverty level, and self-reported general health status
Arah (2008) [13]BritainAssociation between health and votingStudy demonstrates effect of voting abstention in the UK general election and socioeconomic status on self-reported health
Abstaining from voting in 1979, 1981, 1997 and 2001 increased odds of poor health in 1981 (1.56, 95% CI 1.36 to 1. 79), 1991 (1.37 95% CI 1.18 to 1.60), 2000 (1. 45, 95% CI 1.28 to 1.66), and 2004 (1.30, 95% CI 1.11 to 1.51).
Self-reported health; self-reported voting in the UK general election (data from National Child Development Study)Sex, geographic region, age at leaving education, body mass index, chronic illness, and smoking and alcohol consumption frequencies
Ballard, Hoyt, & Pachucki (2018) [14]USAAssociation between health and votingPositive association between civic engagement during late adolescence/early adulthood, and socioeconomic status and mental health in adulthood (decreased risky health behaviors (ES = − 0.12, SE = 0.018, p < 0.001) and fewer depressive symptoms (ES = −0.056, SE = 0.018, p = 0.003)General health, symptoms, physical limitations, depressions, BMI, physical activity, health risk behaviors; Self-reported voting in the US presidential election (data from National Longitudinal Study of Adolescent to Adult Health)Demographic characteristics, health variables, social connections
Blakely, Kennedy & Kawachi (2001) [6]USAAssociation between health and votingSocioeconomic inequality in the US state election voter turnout is associated with poor self-rated health, independent of income inequality and household income.
Individuals living in the USA with highest voting inequality 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 USA with lowest voting inequality.
Self-reported health; self-reported voting in the US State elections (data from Current Population Survey)Income and state level inequality; age, sex, race, and equivalized household income at individual level
Burden et al. (2017) [15]WI, USAAssociation between health and votingPositive association between cognitive functioning and voting, and health functioning and voting in older Wisconsin population
Better health boosts likelihood of voting by 5% in the 2008 election to 15% in the 2012 election.
Cognitive functioning, Health Utilities Index (HUI); Catalist voting records for the 2008, 2010, and 2012 US State elections (data from Wisconsin Longitudinal Study)IQ, age, income, education, gender
Couture and Breux (2017) [16]CanadaAssociation between health and votingPositive association between self-rated health and national electoral participation (statistically significant)
Positive association between self-rated mental health and municipal electoral participation (reduction in participation of 9.1% for local elections between the respondents who reported “very good” health and “very bad” health)
Self-rated health; self-reported voter turnout to Canadian federal and municipal elections (data from Canada General Survey 2013)Socio-demographic, socio-economic, and social capital data
Denny and Doyle (2007) [17]IrelandAssociation between health and votingPositive significant association between subjective health and likelihood to vote in the Irish general election: an individual who reports bad health is 6.7% less likely to vote
No association between psychological well-being and voter turnout
Subjective health and mental well-being (WHO-5); 2002 General Ireland election (data from European Social Survey 2005)Education, sex, age, union membership, political ideology, income, father’s education
Denny and Doyle (2007) [18]BritainAssociation between health and votingPositive association between voting in the general election and general health and mental health in Britain between 1979–1997
Negative association between smoking and voting
Individuals with poor health are 4% less likely to vote in the 1979 and 1997 elections
Smokers are 4% less likely to vote in 1979 and 1997 and 3% less likely to vote in the 1987 election compared to non-smokers.
Self-rated general health, the Malaise Inventory score and indicators of smoking and alcohol consumption; self-reported voter turnout in the 1979, 1987, and 1997 general UK electionsSex, education, marital status, children, employment, family social class.
Habibov and Weaver (2014) [19]CanadaAssociation between health and votingPositive significant association between social capital and self-rated health in Canada
Positive association of voting at all levels and self-rated health in Canada (largest positive effect on self-rated health among all of the social capital variables analyzed)
Self-rated health; self-reported voting at local, provincial, or federal level of Canadian government (data from Canada General Survey 2008)Various sociodemographics such as age, sex, marital status, level of education, and income
Islam et al. (2006) [20]SwedenAssociation between health and votingPositive association between municipal-level social capital (measured as voting) and better health in Sweden
A municipality with a voting turnout rate 10% higher (compared to the mean election participation rate) is associated with a 2.4% higher health state score.
Generic health-related quality of life measure (HRQoL); rates of voting participation in municipal political elections (data from Statistic Sweden’s Survey of Living Condition)Income, gender, immigration, cohabitation, education, employment, age
Islam et al. (2008) [21]SwedenAssociation between health and votingReduced individual risk from all-cause mortality for males 65+ who registered for municipal election participation
Higher voting rate negatively and significantly associated with the mortality risk from cancer for males (p = 0.007), and protective associations for cardiovascular mortality (p = 0.134) and deaths due to “other external causes” (p = 0.055)
Association did not hold for females.
Survival time in years and survival status at the end of follow-up period; registered Swedish municipal election participationIncome inequality, initial health status, age, income, education
Iversen (2008) [22]NorwayAssociation between health and votingPositive association of voting in municipal elections and self-assessed health in Norway
The association is of considerable magnitude.
Self-assessed general health and self-assessed mental health; number of votes as a proportion of the number entitled to vote in the Norwegian local elections (data from standard-of-living survey by Statistics Norway and other sources)Income, education
Kim and Kawachi (2006) [23]USAAssociation between health votingPositive association between presidential electoral participation and health in the USA
Those who had high social trust and electoral political participation had significantly lower odds of fair/poor health (OR = 0.56, 95% CI = 0.52–0.62; and OR = 0.78, 95% CI = 0.71–0.86, respectively).
Self-rated health; self-reported voting in the 1996 presidential election and being currently registered to vote (data from Social Capital Benchmark Study)Age, gender, race/ethnicity, marital status, education, income, and social capital characteristics
Kim, Kim, and You (2015) [24]OECD countriesAssociation between health and votingSignificant positive association between voting in the parliamentary election and subjective health controlling for sociodemographic factors
Negative association between non-conventional political participation and health
Self-rated health; self-reported voting in parliamentary elections in 44 OECD countries globally (data from World Value Survey)Age, sex, marital status, education, and income
Lahtinen et al. (2017) [25]FinlandAssociation between health and votingResults show that health exerts independent effects on voting turnout in the Finnish parliamentary, presidential, and municipal elections.
Income partially mediates the effects of social capital on voting.
Use of healthcare services (including hospitalization data) and medicine purchases; individual-level register the 1999 Finnish parliamentary election and the 2012 presidential and municipal election (data from Statistics Finland)Income, social class, age, gender, living with a partner, native language, and education
Mattila et al. (2013) [26]EuropeAssociation between health and votingSignificant positive association between health and voter turnout in the European parliamentary elections, with effect most notable in older people
The difference in voting probability between respondents with very good health and very bad health is 10%.
The impact of health is partially mediated by social connectedness.
Self-rated health; self-reported voting in the last parliamentary election (data from European Social Survey)One model accounted for age, gender, and education
Reitan (2003) [27]RussiaAssociation between health and votingPositive association between voter turnout in the Russian elections and life expectancy in Russia for both sexes (studied elections from 1991–1999)
Overall, correlations were positive and significant.
Regional data on life expectancy (State Committee of the Russian Federation on Statistic); data on voter turnout collected from the Centre for Russian Studies at the Norwegian Institute of International Affairs (NUPI)Unclear
Agran, MacLean, and Kitchen (2016) [28]Western USADifferences in voting associated with healthQualitative article focused on lower voting rates in individuals with intellectual disabilities, and barriers and supports needed to support this community
Results indicated that people with ID are interested in voting but do not receive education on political issues or voting-related decisions.
Not applicableNot applicable
Ard et al.(2016) [29]USADifferences in voting associated with healthSignificant positive association between engagement in politics (including voting in any US election) and self-rated health in connection to racial health disparities in the USA
Social capital mediates racial disparities in health more than industrial air pollution.
Self-rated health; composite measure of electoral participation which included whether the respondent voted in the past election and is currently registered to vote (data from 2000 Social Capital Benchmark Study).Age, sex, region of residence, marital status, and educational attainment
Bazargan, Kang, and Bazargan (1991) [7]USADifferences in voting associated with healthPositive association of self-rated health and voting in the US presidential election in elderly Caucasian populations: elderly Caucasians who report poor health are 13.1% less likely to vote than those reporting excellent health
Positive association of life satisfaction and voting in elderly African American populations
Self-reported health; self-reported voting turnout from the US presidential election of 1980Income, education, age, gender, living arrangement, marital status, club participation, volunteer work, health status, life satisfaction, transportation, fear of crime, union membership, demand on resources, political efficacy, political philosophy
Bazargan, Barbe, and Torres-Gil (1992) [8]New Orleans, USADifferences in voting associated with healthPositive association between self-rated health and voting for elderly black populations in the US elections: self-reported health status was significantly negatively associated with the number of elections voted in in the bivariate analysis, but not significant in multivariate regression analysisSelf-rated health; self-reported voting in seven elections included presidential, gubernatorial, senatorial, congressional, mayoral elections, and two propositional electionsAge, gender, education, income, accessibility of transportation, church participation, volunteer work, club participation, sense of external efficacy, sense of citizen duty, attention to public affairs, perceived difference between parties, strength of party identification
Bergstresser, Brown, and Colesante (2013) [30]New York City, USADifferences in voting associated with healthQualitative study on the power of voting, social recovery, and inclusion for those with mental health issuesNot applicableNot applicable
Gollust and Rahn (2015) [31]USADifferences in voting associated with healthSignificant negative association between voting and those with heart disease and disabled populations in the 2008 US presidential election
Significant positive association between voting, emotional support, and those with cancer
Self-reporting of chronic health condition, including diabetes, arthritis, angina/coronary heart disease), asthma, and cancer; self-reported voting in the last US presidential election (data from 2009 Behavioral Risk Factor Surveillance Survey)Sociodemographic characteristics (age, gender, race, income, education, urbanicity) and health-related confounding factors (health insurance, disability, emotional support)
Kawachi et al. (1999) [32]USADifferences in voting associated with healthNegative association between female voting rate and female mortality rate: higher political participation was correlated with lower female mortality rates (r = − 0.51)
In regression analysis, a one-unit improvement in political participation was associated with 7.3 fewer deaths per 100,000 women (95% confidence interval, CI: 3.8 to 10.9).
Total female and male mortality rates, female cause-specific death rates and mean days of activity limitations reported by women during the previous month (data from CDC); voter registration (percent women registered to vote in 1992/94), voter turnout (percent women who voted in 1992/94)Income distribution (using the adjusted Gini coefficients), median income and poverty rates
Matsubayashi and Ueda (2014) [33]USADifferences in voting associated with healthNegative association between voting in the US presidential election and adults with disabilities compared to population without disabilities
The odds of voting in the presidential elections from 1980 to 2008 are 50–60% lower if the respondents have work-preventing disabilities, taking into account socioeconomic factors.
Self-reported work preventing disabilities; self-reported voting rates (data from Current Population Survey)Education and income, age, gender, and race and ethnicity
Mattila and Papageorgiou (2017) [34]EuropeDifferences in voting associated with healthNegative association between voting in the European national elections and disability; perception of discrimination increases this trend
The probability of a non-disabled person voting is 80%, while the corresponding probability for those with disability and discrimination experiences is 75% (p < 0.01).
Disability status and disability discrimination; self-reported voting (data from European Social Survey 2012).Age, gender, education, social connectedness
Mino et al. (2011) [35]New York City, USADifferences in voting associated with healthNegative association between being registered to vote in the US elections (all levels) and drug paraphernalia sharing
In bivariate analysis, those registered to vote were less likely to share drug paraphernalia (33% vs. 49%; p = 0.046). This significance decreased in multivariate analysis, where political party identification was associated with lower drug paraphernalia sharing (adjusted odds ratio (AOR) = 0.363, CI = 0.155–0.854; p = 0.020).
Injection drug use health variables (sharing paraphernalia, using shooting galleries) in past 30 days; self-reported voter registration, identifying as political/part of an organized political party and attention paid to politicsAll regression models controlled for age, gender, and educational level
Ojeda (2015) [36]USADifferences in voting associated with healthNegative association between depression and political participation (measured as voting in the US presidential election)
Respondents who report no depressed mood have a 0.75 probability of voting, while respondents who report the most severe depressed mood have a probability of voting of < 0.5.
Self-reported mental health status including Center for Epidemiologic Studies Depression Scale (CES-D); self-reported voter turnout in the 1996 and 2000 US presidential elections (data from 1998 General Social Survey and the National Longitudinal Study of Adolescent Health)Sex, race, education, age, general health, parental income, education, civic engagement, general health, marital status, church attendance, self-reported happiness (depending on data used)
Shields, Schriner, and Schriner (1998) [37]USADifferences in voting associated with healthNegative association between voter registration/voting rates in the 1994 US mid-term election and people with disabilities
Among non-disabled respondents, 54% reported voting, while 33.1% of the people with disabilities reported voting.
Self-reported disability causing lack of work participation; self-reported registered and voted, were registered but did not vote, and voted absentee in the 1994 mid-term election (data from 1994 Current Population Survey)Education, income, age, years of living in the community, and marital status
Sund et al. (2017) [38]FinlandDifferences in voting associated with healthAssociation between chronic diseases and voting in the Finnish parliamentary elections: neurodegenerative brain diseases (dementia OR = 0.20, 95% CI 0.18 to 0.22), alcoholism (OR = 0.66), and mental disorders (depression OR = 0.91; psychotic mental disease OR = 0.79) had a significant negative association, whereas cancer and COPD/asthma had a positive association (both OR = 1.05). Having more than one condition further decreased voting probability (1 condition OR = 0.96, 2 conditions OR = 0.83, 3 conditions OR = 0.68 and 4+ conditions OR = 0.50)Hospital discharge diagnoses and reimbursements for drugs prescribed, to identify persons with 17 chronic hospital-treated diseases; individual-level register records for the 1999 Finnish parliamentary electionsGender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalization during election day
Urbatsch (2017) [39]Finland, USADifferences in voting associated with healthAssociation between low voter turnout and influenza outbreaks in USA and Finland
In Finland, influenza prevalence reduces turnout in Finnish residential, parliamentary, and municipal elections by 2.1% (95% CI: 21.2 to 23.1 percentage points). In the USA, a higher level of influenza reduces turnout in the US presidential and state elections by 1.2% (95% CI: 20.4 to 22.1).
Influenza infections; voter turnout is measured as a share of the voting-eligible population at major elections (statistics from the national Finnish and US surveillance systems)Healthcare access, population > 65, population per square meter, type of election
Rodriguez (2018) [40]USAElectoral implicationsPositive association between health and political participation causes early mortality of poor people.
Health differences between 10-year survivors and non-survivors explain 56% of their differences in socio-political participation. Without detrimental differences in health, individuals would participate 28% more as they age. High-SES survivors participate 60% more than low-SES survivors and 85% more than low-SES non-survivors.
Mortality status and self-rated health; index of political participation (volunteering, attending meetings, and giving money) (data from Midlife in the United States: a national study of health and well-being)Education, income
Rodriguez et al. (2015) [41]USAElectoral implicationsExcess mortality in African American populations from 1970 to 2004 (2.7 million deaths) due to health inequality affected 2004 US presidential and state election outcomes (1 million lost black votes)Deaths by state (data from Multiple Cause of Death files 1970–2004); total number of votes by state (data from US Elections Project, National Election Pool General Election Exit Polls (2004).Sex, race, age, region
Ziegenfuss, Davern and Blewett (2008) [42]USAElectoral implicationsComparison of proportion of those who delayed accessing health care and voted in 2004 compared with the 2000 US national election
Those who delay healthcare care were less likely to vote than those who did not in 2000, but not in 2004. In 2004, those who delayed care and voted were more than twice as likely to vote Democratic than Republican.
Access to healthcare; self-reported voting in the 2000 and 2004 presidential elections (data from American National Election Study)Age, gender, race/ethnicity, income, marital status, educational attainment, party identification, home ownership, church attendance, and length of time residing in the same home or apartment
Anderson and Dabelko-Schoeny (2010) [43]USAHealthcare interventionsCommentary on civic engagement leading to better health in nursing home residents from social worker perspective, with call to action for social works to engageNot applicableNot applicable
Hassell and Settle (2017) [44]USAHealthcare interventionsStudy experimented with interventions on life stress and likelihood to vote in the US presidential and municipal elections
When triggered with life stressors, individuals without a history of voting were significantly less likely to vote while routine voters were unaffected. Non-voters exposed to the life stressors reduced likelihood of voting by 5%.
Life stressors; self-reported voting in the 2012 US presidential election and the 2013 municipal election in a small Midwestern American townUsed control groups in field experiments
Liggett et al. (2014) [45]Bronx, USAHealthcare interventionsStudy examined a clinician-led voter registration drive within 2 university-affiliated health centers in the Bronx, New York.
38% of the total patients engaged in voter registration drive were registered to vote for the 2008 US presidential election: 114 of the 304 patients engaged were registered, of which 54% were first-time registrants
Not applicableNot applicable
Regan, Hudson, and McRory (2011) [46]USAHealthcare interventionsLiterature review of patient participation in public elections, with call to action for nurses to engage in promoting patients’ right to vote through policy guidelines and a flexible and proactive nursing approach to participationNot applicableNot applicable
Wass et al, (2017) [47]EuropeHealthcare interventionsVoter facilitation instruments (advance/postal voting, voting outside the polling stations) for parliamentary elections in 30 European countries have insignificant effects to increase electoral participation for those suffering from ill health or disabilities (except proxy voting)Self-rated disability and self-rated health; self-reported voter turnout (data from European Social Survey)Gender, age, education and cohabitation with a spouse
White and Wyrko (2011) [48]UKHealthcare interventionsCommentary encouraging voter outreach in the UK elections to older patients admitted to geriatric rehab hospitalNot applicableNot applicable