Liu Sze Yan
Montclair State University, Department of Public Health, New Jersey, USA.
Public Health. 2023 Mar;216:7-12. doi: 10.1016/j.puhe.2022.12.007. Epub 2023 Feb 1.
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.
This was a repeated cross-sectional study.
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.
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).
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.
尽管女性占人口的50%，但在政府中女性的代表性仍然不足。不公平的女性政治代表性是结构性性别歧视的一种形式，可能会影响人口健康。以往的研究主要集中在个人健康行为以及低收入或中等收入国家。迄今为止，尚无研究在美国考察女性政治代表性与医疗保健可及性和利用率之间的关联，而这是直接与政策相关的结果。
这是一项重复横断面研究。
本研究使用了来自《县排名》的2013 - 2018年县级数据。我进行了多层次分析，以确定州级女性代表性（州立法机构中女性的百分比）与两个结果之间的关系——65岁以下未参保县级人口的百分比（主要结果）以及县级可预防住院率（感兴趣的次要结果）。潜在的混杂因素包括县级和州级特征，如失业率。我还研究了这些关联是否因州立法机构的政党控制情况而有所不同。
在完全调整模型中，女性政治代表性一个标准差的差异与县级未参保率降低0.22个百分点相关（95%置信区间 = -0.32，-0.12）。女性政治代表性与可预防住院率之间的关联因州的政党控制情况而异，仅在民主党/分裂控制的州的县中发现有所降低（-80.51，95%置信区间 = -149.65，-11.38）。
结果表明，解决女性在政府中代表性不足问题的政策干预可能有助于提高未参保率，并且在某些情况下，降低县级不必要的住院率。然而，需要进一步研究以更好地理解政党控制在改变上述关联中的作用。
