184 - Associations Among Area-Level Voter Participation, Socioeconomic Deprivation, and Neonatal Health Outcomes

Publication Number: 1173.184

Margaret N. Jones, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Carson S. Hartlage, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Cole Brokamp, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Andrew F. Beck, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Samantha L.. Simpson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Tierra M. Dennis, CCHMC, Cincinnati, OH, United States; Sarah J.. Kopp, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Miller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Voting is an important political determinant of health which can impact other social drivers of health, resulting in either equity or inequity in health outcomes. In prior analyses, we found that voting rates were negatively correlated with rates of pediatric hospitalization at the census tract level. However, to our knowledge, no research has explored connections between voting and neonatal health outcomes.

Objective: To assess associations among census tract-level voter participation and neonatal health outcomes during 2020-2024 in Hamilton County, Ohio.

Design/Methods: This was a retrospective ecological study approved by our Institutional Review Board. Outcomes of interest included rates of preterm birth ( < 37 weeks gestational age) and low birth weight ( < 2500 grams) measured at the census tract level. The exposure variables were census tract-level rates of voter participation (proportion of total adult population who voted) in the 2020, 2022, and 2024 elections. To estimate the impact of the exposure on the outcomes, we used descriptive statistics and regression models adjusted for census tract-level socioeconomic deprivation index.

Results: There were 10,306, 10,222, and 9,909 births in 2020, 2022, and 2024, respectively, in Hamilton County, Ohio. Median preterm birth rates ranged 11-12 per 100 births; median low birth weight rates were 10 per 100 births. Mean voter participation rates were 0.53 (2020), 0.39 (2022), and 0.56 (2024). Figures 1 and 2 depict maps and bivariate comparisons for 2024; similar patterns were observed for 2020 and 2022. For each election year, a decline in voter participation rates was associated with worse neonatal health outcomes. After adjusting models for socioeconomic deprivation, voter participation was not associated with rates of preterm birth and low birth weight (Table).

Conclusion(s): We found associations among census tract-level rates of voter participation, socioeconomic deprivation, and neonatal health outcomes across a single county in southwest Ohio. Socioeconomic deprivation and voter participation were highly negatively correlated, with census tracts with higher deprivation having lower voter participation. Future work could explore potential causality and mechanisms underlying these relationships, as well as the impact of population-level voter engagement interventions on neonatal health outcomes.

Figure 1. Maps of Hamilton County, Ohio, depicting 2024 census tract rates of neonatal health outcomes, voter participation, and deprivation index


Figure 2. Scatter plots assessing 2024 election voter participation rates, deprivation index, and neonatal health outcome rates (counts per 100 births) at the census tract level. The deprivation index reflects multiple variables available from the US Census American Community Survey; values range from 0 to 1 (median 0.30), with higher values reflecting greater deprivation.
***Spearman's correlation coefficient, p < 0.001

Table. Incident rate ratios (and 95% confidence intervals) for associations between voter participation, deprivation index, and neonatal health outcomes for 2020, 2022, and 2024.
*Example interpretation (unadjusted model): At the census tract level, for each 10% increase in the voter participation rate, we would expect a 9% decrease in the preterm birth rate.
**Example interpretation (adjusted model): After adjusting for deprivation index, changes in voter participation rates are not associated with expected changes in preterm birth rates.