Analysis of Reported Voting Behaviors of US Physicians, 2000-2020

This cross-sectional study assesses the trends in physician-voter turnout and reported reasons for not voting in midterm and general US elections from 2000 to 2020.


Introduction
Physicians' engagement with the political process, particularly through voting, plays an important role in shaping public policy, affecting patient health and clinical practice. 1Historically, physicians in the US voted at lower rates than the general population in elections. 2However, physician voter engagement may have evolved, particularly given the changing political landscape and importance of US health care reform, as highlighted by the COVID-19 pandemic and differing policy proposals between the 2 major political parties.We assessed the trends in physician-voter turnout and reported reasons for not voting from 2000 through 2020.

General population Physicians
The analyses are based on data from the Current Population Survey Voting and Registration Supplement.To be consistent with the US Census Bureau's approach, we classified nonresponses and responses of no or do not know to the voter questions as did not vote.All estimates provided in both panels were survey-weighted and adjusted for differences in demographic characteristics.Using a regression-based equivalent approach of standardization, these estimated risk ratios quantify the mean association between the physician occupation and voting participation in the overall population.
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Methods
This cross-sectional study was exempted from review and informed consent by the institutional review board at Harvard Pilgrim Health Care because of the use of publicly available, deidentified data.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.We used the US Census Bureau Current Population Survey Voting and Registration Supplement data. 3This survey is administered biennially to 60 000 households and collects information on voter participation and registration in the weeks following an election day.The response rates ranged from 79% to 92% in 2000 to 2020.
We estimated marginal probabilities of voter turnout (ie, the proportion of eligible individuals who voted) in physicians and the general population in each election, respectively, using multivariable logistic regression and adjusting for demographic characteristics strongly associated with voting. 4We evaluated differences in voter turnout between physicians and the general population using risk ratios (RRs) and χ 2 tests, both pooled and individually in each election.We examined the impact of sex, age, and availability of no-excuse mail-in voting on physician voter turnout.To examine barriers to voting among physicians, we calculated the proportions of eligible physicians who cited each reason for not voting and not registering to vote, respectively.All estimates were weighted to be nationally representative.
b To be consistent with the US Census Bureau's approach, we classified nonresponses and responses of either no or do not know to the registration questions as not registered.
c Other reasons for not voting include: illness or disability, forgot to vote, transportation problems, didn't like candidates, registration problems (didn't receive absentee ballot, not registered in current location), bad weather conditions, inconvenient polling place, concerns about COVID-19 pandemic, and other reasons.They were combined into a single category because of the small number of physicians who cited them.

JAMA Network Open | Health Policy
Analysis of Reported Voting Behaviors of US Physicians, 2000-2020

Figure .
Figure.Marginal Estimated Probabilities and Risk Ratios of Voter Turnout Comparing US Physicians With the General Population, 2000-2020 Probability of voting among US physicians vs general population during presidential elections A Abbreviation: NA, not available.

d
The response other was an answer option in the survey; the survey did not capture what other reasons respondents were referring to.e The survey question regarding why unregistered citizens did not register to vote was not included in the Current Population Survey in election years 2000 and 2002.

Table .
Common Reasons Why Eligible US Physicians Did Not Vote or Register in Presidential and Midterm Elections, 2000-2020