Gerrymandering and the Packing and Cracking of Medical Uninsurance Rates in the United States.

IF 2.2 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Tamara Rushovich, Rachel C Nethery, Ariel White, Nancy Krieger
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引用次数: 0

Abstract

Context: Technological innovation and access to big data have allowed partisan gerrymandering to increase dramatically in recent redistricting cycles.

Objective: To understand whether and how partisan gerrymandering, including "packing" and "cracking" (ie, respectively concentrating within or dividing specified social groups across political boundaries), distorts understanding of public health need when health statistics are calculated for congressional districts (CDs).

Design: Cross-sectional study using 2020 CDs and nonpartisan simulated districts.

Setting: United States, 2017-2021.

Participants: United States residents.

Main outcome measure: Percent with no medical insurance (uninsured), within-district variance of percent uninsured, and between-district variance of percent uninsured.

Results: At the state level, states where partisan redistricting plans showed greater evidence of partisan gerrymandering were more likely to contain CDs with more extreme values of uninsurance rates than districts in states with less evidence for gerrymandering (association between z-scores for gerrymandering and between-district variation in uninsurance = 0.25 (-0.04, 0.53), P  = .10). Comparing variation in uninsurance rates for observed CDs vs nonpartisan simulated districts across all states with more than 1 CD, in analyses stratified by state gerrymander status (no gerrymander, Democratic gerrymander, and Republican gerrymander), we found evidence of particularly extreme distortion of rates in Republican gerrymandered states, whereby Republican-leaning districts tended to have lower uninsurance rates (the percentage of Republican-leaning districts that were significantly lower than nonpartisan simulated districts was 5.1 times that of Democratic-leaning districts) and Democrat-leaning districts had higher uninsurance rates (the percentage of Democrat-leaning districts that were significantly higher than nonpartisan simulated districts was 3.0 times that of Republican-leaning districts).

Conclusions: Partisan gerrymandering can affect determination of CD-level uninsurance rates and distort understanding of public health burdens.

Gerrymandering and the Packing and Cracking of Medical Uninsurance Rates in the United States.
背景:技术创新和大数据的获取使得党派选区划分在最近的选区重划周期中急剧增加:目的:了解在计算国会选区(CD)的健康统计数据时,党派选区划分(包括 "打包 "和 "分裂",即分别集中在特定社会群体内部或跨越政治边界划分特定社会群体)是否以及如何扭曲对公共卫生需求的理解:设计:使用 2020 年国会选区和无党派模拟选区进行横断面研究:参与者:美国居民:主要结果测量没有医疗保险(未参保)的百分比、未参保百分比的区内差异和未参保百分比的区间差异:在州一级,与选区划分证据较少的州相比,选区划分计划中党派选区划分证据较多的州更有可能包含未投保率极端值较高的选区(选区划分 Z 值与未投保率地区间差异之间的关系 = 0.25 (-0.04, 0.53), P = .10)。在按州 "gerrymander "状况(无 "gerrymander"、民主党 "gerrymander "和共和党 "gerrymander")分层的分析中,我们比较了所有有 1 个以上 "gerrymander "的州中观察到的 "gerrymander "与无党派模拟选区的未保险率的变化,发现在共和党 "gerrymander "的州中,有证据表明未保险率被极度扭曲,即共和党倾向选区的未保险率往往较低(共和党倾向选区显著低于无党派模拟选区的百分比是民主党倾向选区的 5.1 倍)。1倍),而民主党倾向地区的未保险率较高(民主党倾向地区显著高于无党派模拟地区的百分比是共和党倾向地区的3.0倍):结论:党派选区划分会影响选区层面未参保率的确定,并扭曲对公共卫生负担的理解。
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来源期刊
Journal of Public Health Management and Practice
Journal of Public Health Management and Practice PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
3.40
自引率
9.10%
发文量
287
期刊介绍: Journal of Public Health Management and Practice publishes articles which focus on evidence based public health practice and research. The journal is a bi-monthly peer-reviewed publication guided by a multidisciplinary editorial board of administrators, practitioners and scientists. Journal of Public Health Management and Practice publishes in a wide range of population health topics including research to practice; emergency preparedness; bioterrorism; infectious disease surveillance; environmental health; community health assessment, chronic disease prevention and health promotion, and academic-practice linkages.
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