{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:44:28Z","timestamp":1776354268240,"version":"3.51.2"},"reference-count":72,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG055481"],"award-info":[{"award-number":["R01AG055481"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec><jats:label\/><jats:p>\n<jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>Policy Points<\/jats:title><\/jats:caption><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working\u2010age mortality rates, which predate the COVID\u201019 pandemic.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Eroding electoral democracy in a US state was associated with higher working\u2010age mortality from homicide, suicide, and especially from drug poisoning and infectious disease.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>State and federal efforts to strengthen electoral democracy, such as banning partisan gerrymandering, improving voter enfranchisement, and reforming campaign finance laws, could potentially avert thousands of deaths each year among working\u2010age adults.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:boxed-text><\/jats:p><\/jats:sec><jats:sec><jats:title>Context<\/jats:title><jats:p>Working\u2010age mortality rates are high and rising in the United States, an alarming fact that predates the COVID\u201019 pandemic. Although several reasons for the high and rising rates have been hypothesized, the potential role of democratic erosion has been overlooked. This study examined the association between electoral democracy and working\u2010age mortality and assessed how economic, behavioral, and social factors may have contributed to it.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the State Democracy Index (SDI), an annual summary of each state's electoral democracy from 2000 to 2018. We merged the SDI with annual age\u2010adjusted mortality rates for adults 25\u201364 years in each state. Models estimated the association between the SDI and working\u2010age mortality (from all causes and six specific causes) within states, adjusting for political party control, safety net generosity, union coverage, immigrant population, and stable characteristics of states. We assessed whether economic (income, unemployment), behavioral (alcohol consumption, sleep), and social (marriage, violent crime, incarceration) factors accounted for the association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Increasing electoral democracy in a state from a moderate level (defined as the third quintile of the SDI distribution) to a high level (defined as the fifth quintile) was associated with an estimated 3.2% and 2.7% lower mortality rate among working\u2010age men and women, respectively, over the next year. Increasing electoral democracy in all states from the third to the fifth quintile of the SDI distribution may have resulted in 20,408 fewer working\u2010age deaths in 2019. The democracy\u2013mortality association mainly reflected social factors and, to a lesser extent, health behaviors. Increasing electoral democracy in a state was mostly strongly associated with lower mortality from drug poisoning and infectious diseases, followed by reductions in homicide and suicide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Erosion of electoral democracy is a threat to population health. This study adds to growing evidence that electoral democracy and population health are inextricably linked.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1468-0009.12658","type":"journal-article","created":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T12:23:14Z","timestamp":1685103794000},"page":"700-730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Electoral Democracy and Working\u2010Age Mortality"],"prefix":"10.1111","volume":"101","author":[{"given":"JENNIFER KARAS","family":"MONTEZ","sequence":"first","affiliation":[{"name":"Syracuse University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KENT JASON","family":"CHENG","sequence":"additional","affiliation":[{"name":"Syracuse University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JACOB M.","family":"GRUMBACH","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"High and Rising Mortality Rates Among Working\u2010Age Adults","author":"National Academies of Sciences, Engineering, and Medicine","year":"2021"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.16932"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1257\/jep.35.4.123"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12469"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0275466"},{"key":"e_1_2_6_7_1","volume-title":"Laboratories Against Democracy: How National Parties Transformed State Politics","author":"Grumbach JM","year":"2022"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0003055422000934"},{"key":"e_1_2_6_9_1","volume-title":"How Democracies Die","author":"Levitsky S","year":"2018"},{"key":"e_1_2_6_10_1","doi-asserted-by":"crossref","unstructured":"WillisonCE FalkenbachM GreerSL SingerPM.Backsliding among indicators of democratic stability relevant to public health: risks in OECD nations.World Med Health Policy. Published online December 25 2022.https:\/\/doi.org\/10.1002\/wmh3.558","DOI":"10.1002\/wmh3.558"},{"key":"e_1_2_6_11_1","unstructured":"Statement in Support of the Freedom to Vote Act.New America. November 21 2021. Accessed December 31 2022.https:\/\/www.newamerica.org\/political\u2010reform\/statements\/statement\u2010in\u2010support\u2010of\u2010the\u2010freedom\u2010to\u2010vote\u2010act\/"},{"key":"e_1_2_6_12_1","unstructured":"BergerM.U.S. listed as a \u2018backsliding\u2019 democracy for first time in report by European think tank.The Washington Post. November 22 2021. Accessed December 27 2022.https:\/\/www.washingtonpost.com\/world\/2021\/11\/22\/united\u2010states\u2010backsliding\u2010democracies\u2010list\u2010first\u2010time\/"},{"key":"e_1_2_6_13_1","unstructured":"BouieJ.TheU.S.thinks \u2018it can't happen here.\u2019 It already has.New York Times. October 18 2022. Accessed May 1 2023.https:\/\/www.nytimes.com\/2022\/10\/18\/opinion\/democracy\u2010america\u2010authoritarianism\u2010midterms.html"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/9781108957809"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1071\/he07177"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-68930-2_28"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/00221465211025963"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(06)69341\u20100"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467\u20109566.2011.01339.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0277\u20109536(00)00197\u20100"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2017.07.003"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)30235\u20101"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech\u20102022\u2010218920"},{"key":"e_1_2_6_24_1","unstructured":"L\u00fchrmannA MaerzSF GrahnS et\u00a0al.Autocratization Surges \u2010 Resistance Grows.Varieties of Democracy Institute.2020. Accessed November 12 2022.https:\/\/www.v\u2010dem.net\/publications\/democracy\u2010reports\/"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2016.04.011"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1215\/03616878\u20109978103"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.03.033"},{"key":"e_1_2_6_28_1","first-page":"1995","article-title":"The challenge of the new preemption","volume":"70","author":"Briffault R","year":"2018","journal-title":"Stanford Law Rev"},{"key":"e_1_2_6_29_1","doi-asserted-by":"crossref","unstructured":"CoombsE TheobaldN AllisonA et\u00a0al.Explaining the positive relationship between state\u2010level paid family leave and mental health.Community Work Fam. Published online November 11 2022.https:\/\/doi.org\/10.1080\/13668803.13662022.12140029","DOI":"10.1080\/13668803.2022.2140029"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2022.06.005"},{"key":"e_1_2_6_31_1","unstructured":"MontanaroD.Poll: more Americans are concerned about voting access than fraud prevention.NPR. July 2 2021. Accessed March 23 2023.https:\/\/www.npr.org\/2021\/07\/02\/1012302107\/poll\u2010more\u2010americans\u2010are\u2010concerned\u2010about\u2010voting\u2010access\u2010than\u2010fraud\u2010prevention"},{"key":"e_1_2_6_32_1","unstructured":"American Psychological Association.Stress in America 2022.2022. Accessed March 22 2023.https:\/\/www.apa.org\/news\/press\/releases\/stress\/2022\/concerned\u2010future\u2010inflation"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100297.00570"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010028211269"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jce.2007.06.001"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/1362480613499793"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1088767915611178"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302184"},{"key":"e_1_2_6_39_1","volume-title":"Invisible Punishment: The Collateral Consequences of Mass Imprisonment","author":"Chesney\u2010Lind M","year":"2003"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20102667(20)30283\u20108"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305413"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.025168"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mph022"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2021.102644"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt252"},{"key":"e_1_2_6_46_1","unstructured":"University of Kentucky Center for Poverty Research.UKCPR national welfare data 1980\u20132019.2021. Accessed March 15 2022.http:\/\/ukcpr.org\/resources\/national\u2010welfare\u2010data"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0130119"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1017\/S153759271700425X"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajps.12219"},{"key":"e_1_2_6_50_1","unstructured":"HirschBT MacphersonDA EvenW.Union membership and coverage database.2023. Accessed March 29 2023.https:\/\/unionstats.com\/"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.2307\/3590942"},{"key":"e_1_2_6_52_1","unstructured":"US Census Bureau.Median Household Income by State (Table H\u20108).2022. Accessed April 8 2023.https:\/\/www.census.gov\/data\/tables\/time\u2010series\/demo\/income\u2010poverty\/historical\u2010income\u2010households.html."},{"key":"e_1_2_6_53_1","unstructured":"SlaterME AlpertHR.Apparent per capita alcohol consumption: national state and regional trends 1977\u20132019.National Institute on Alcohol Abuse and Alcoholism.2021. Accessed October 1 2022.https:\/\/pubs.niaaa.nih.gov\/publications\/surveillance117\/SR\u2010117\u2010Per\u2010Capita\u2010Consumption.pdf"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.4716"},{"key":"e_1_2_6_55_1","unstructured":"National Corrections Reporting Program Series.National Corrections Reporting Program 1991\u20132019: Selected Variables.2021. Accessed September 18 2022.https:\/\/www.icpsr.umich.edu\/web\/NACJD\/studies\/38048"},{"key":"e_1_2_6_56_1","unstructured":"Federal Bureau of Investigation Crime Data Explorer.2022. Accessed September 20 2022.https:\/\/www.cde.ucr.cjis.gov\/LATEST\/webapp\/#\/pages\/home"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1093\/ectj\/utac017"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1080\/07474938.2023.2178139"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.2307\/1913646"},{"key":"e_1_2_6_60_1","doi-asserted-by":"crossref","unstructured":"WooldridgeJM.Two\u2010way fixed effects the two\u2010way Mundlak regression and difference\u2010in\u2010difference estimators.2021. Accessed March 28.https:\/\/www.researchgate.net\/publication\/353938385_Two\u2010Way_Fixed_Effects_the_Two\u2010Way_Mundlak_Regression_and_Difference\u2010in\u2010Differences_Estimators","DOI":"10.2139\/ssrn.3906345"},{"key":"e_1_2_6_61_1","unstructured":"CDC WONDER.Centers for Disease Control and Prevention. Accessed December 3 2022.https:\/\/wonder.cdc.gov\/"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaa432"},{"key":"e_1_2_6_63_1","unstructured":"Brennan Center for Justice.Voting laws roundup: December 2021.2022. Accessed March 23 2022.https:\/\/www.brennancenter.org\/our\u2010work\/research\u2010reports\/voting\u2010laws\u2010roundup\u2010december\u20102021"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.1017\/9781108999601.012"},{"key":"e_1_2_6_65_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.93.3.421"},{"key":"e_1_2_6_66_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.92.5.722"},{"key":"e_1_2_6_67_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.92.5.725"},{"key":"e_1_2_6_68_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003122419848723"},{"key":"e_1_2_6_69_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01414"},{"key":"e_1_2_6_70_1","doi-asserted-by":"publisher","DOI":"10.1177\/00491241221099552"},{"key":"e_1_2_6_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13524\u2010018\u20100750\u2010z"},{"key":"e_1_2_6_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2020.100680"},{"key":"e_1_2_6_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.04.036"}],"container-title":["The Milbank Quarterly"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1468-0009.12658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T11:40:20Z","timestamp":1706960420000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1468-0009.12658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,26]]},"references-count":72,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/1468-0009.12658"],"URL":"https:\/\/doi.org\/10.1111\/1468-0009.12658","archive":["Portico"],"relation":{},"ISSN":["0887-378X","1468-0009"],"issn-type":[{"value":"0887-378X","type":"print"},{"value":"1468-0009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,26]]},"assertion":[{"value":"2023-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}