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A Deep Dive Into the Widening Mortality Gap Across the Political Aisle

New research indicates politics may be a matter of life or death.

A study published June 7 by the BMJ examined mortality rates and voting patterns in the past five presidential elections, and found that people who lived in jurisdictions that consistently voted Democratic fared better than those that voted Republican.

“We all aspire to live in and exist in a sort of system where politics and health don’t intersect,” said Dr. Haider Warraich, the study’s lead author. “But what this paper actually shows is that politics and health, especially in the United States, are deeply intertwined.”

Researchers linked information from the Centers for Disease Control and Prevention WONDER database with data from presidential elections and state governor races to determine how, from 2001 to 2019, political environments factored into an area’s mortality rates. They used age-adjusted rather than raw-number death rates to ensure that differences are not the result of a population’s age. That is helpful, for example, to more fairly compare an area with larger numbers of older residents — who are more likely to suffer from chronic diseases — with areas that may have younger populations.

They classified counties as “Democratic” or “Republican” for the four years that followed a presidential election. They also sought to determine whether such patterns were affected by sex, race, and ethnicity as well as urban or rural status.

Overall, from 2001 to 2019, they found that Democratic counties did better in reducing their age-adjusted mortality rates. During that period, the rate dropped by 22% (from 850 to 664 deaths for every 100,000 residents), compared with an 11% dip in Republican counties (from 867 to 771 deaths for every 100,000 residents).

Bottom line: “The mortality gap in Republican voting counties compared with Democratic voting counties has grown overtime,” the researchers wrote.

“My fear is that this gap will grow even more after the pandemic,” Warraich said.

Warraich emphasized that health policies are not the only factors that shape a community’s well-being. “It’s going to be the economic conditions of those regions; it’s going to be the educational environments; it’s going to be the health behaviors, and it’s going to be health policy as well,” he said. “So what we’re seeing is, really, the cumulative effect of a whole lot of different things.”

The researchers, for instance, pointed to a previous study showing that “more liberal” state policies on tobacco control, labor, immigration, civil rights, and environmental protections were associated with better life expectancy, whereas “more conservative” state policies — such as restrictions on abortion and less stringent gun laws — were associated with lower life expectancy among women.

Left-leaning states were also more likely to enact policies, such as Medicaid expansion under the Affordable Care Act, which sought to widen the safety net for vulnerable populations. Of 12 states that have not expanded their Medicaid programs, nine have Republican governors and 10 voted for former President Donald Trump in 2020.

The mortality-rate patterns between Republican and Democratic counties were generally consistent among racial and ethnic subgroups, such as non-Hispanic Black Americans and Hispanic people. But Black Americans had a higher mortality rate than any other race or ethnicity, regardless of political persuasion.

The gap was most striking among white Americans. The death rate of white residents in Democratic counties, according to the study, dropped by 15% from 2001 to 2019. Meanwhile, white residents in Republican counties saw just a 3% dip. Rural Republican counties experienced the highest age-adjusted mortality rates and the least improvement.

Dr. Steven Woolf, who wrote an editorial to accompany the study, said its findings go beyond a correlation between political values and health.

“If there’s more poverty in an area, if there’s fewer people who’ve graduated from high school, then they’re going to have poorer health outcomes and higher death rates,” Woolf said. “And this happens to be more true and prevalent in Republican counties,” he added. The study, then, is more of a reflection of the economic well-being of certain populations, he said.

Heart disease and cancer remain the leading causes of death in both Democratic and Republican counties, according to the researchers. But declines in these rates were more pronounced in Democratic areas, leading them to write: “Understanding the factors that are contributing to the growing differences in heart disease and cancer mortality across political environments is critically important.” They cite several possibilities — including underlying differences in access to health care and lack of insurance coverage.

Other factors contributing to the widening mortality gap, according to the study, were chronic diseases of the lower respiratory tract, unintentional injuries, and suicide rates.

“So the main message here, which is very important, is that we really have to pay attention in medical research to political party because it affects the outcome,” said Dr. Robert Blendon, a professor of health policy and political analysis at Harvard who was not associated with the study.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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