A slowdown in mortality improvements among white Americans residing in Republican counties between 2001 and 2019 was a major factor in the rise in the disparity in resident death rates across disease categories.
A recent study shows how politics and health outcomes have become more intertwined over time. From 2001 to 2019, researchers from Brigham and Women’s Hospital looked at death rates and information on federal and state elections for all counties in the United States. The researchers discovered a “mortality gap,” or an increasing divergence in age-adjusted death rates in counties that had supported Democrats or Republicans in prior presidential and governor elections.
The research team discovered that death rates dropped by 22% in Democratic counties but only by 11% in Republican areas. Heart disease and cancer were among the top diseases where the mortality disparity increased, and over the research period, the death difference between white inhabitants of Democratic and Republican counties approximately quadrupled. The study’s findings were published in the British Medical Journal.
“In an ideal world, politics and health would be independent of each other and it wouldn’t matter whether one lives in an area that voted for one party or another,” said corresponding author Haider Warraich, MD, of the Division of Cardiovascular Medicine at the Brigham. “But that is no longer the case. From our data, we can see that the risk of premature death is higher for people living in a county that voted Republican.”
Key Causes of the Mortality Disparity
Data from the CDC WONDER database and the MIT (Massachusetts Institute of Technology) Election Data and Science Laboratory were both used by Warraich and his colleagues. Based on how a county had voted in the last presidential election, they classed counties as Democratic or Republican. Mortality rates were also adjusted for age.
Overall, the team found that mortality rates in Democratic counties dropped from 850 deaths per 100,000 people to 664 (22 percent), but in Republican counties, mortality rates declined from 867 to 771 (11 percent). When the team analyzed by race, they found that there was little gap between the improvements in mortality rates that Black and Hispanic Americans experienced in Democratic and Republican counties. But among white Americans, the gap between people living in Democratic versus Republican counties was substantial.
The mortality gap remained consistent when the researchers looked only at counties that had voted Republican or Democratic in every presidential election year studied and when they looked at gubernatorial elections. Democratic counties experienced greater reductions in mortality rates across most common causes of death, including heart disease, cancer, chronic lower respiratory tract diseases, diabetes, influenza and pneumonia, and kidney disease.
The Impact of the Affordable Care Act on Mortality
The authors note that the widening gap in death rates may reflect the influence of politics on health policies. One of the inflection points detected in the study corresponds to the Affordable Care Act (ACA), which was passed in 2010. More Democratic states than Republican states adopted Medicaid expansion under the ACA, which expanded health insurance coverage to people with a low income.
The study detects an association between political environment and mortality but does not definitively determine the direction of the association or the specific factors that may explain the link between the two. The authors did not study the effect of flipping political environments — that is, counties that switched from voting Democratic or Republican to vote for the other party — on health outcomes, which could be an area of future study. The study period ended in 2019, before the start of the COVID-19 pandemic, which may have had an even more profound impact on the mortality gap.
“Our study suggests that the mortality gap is a modern phenomenon, not an inevitability,” said Warraich. “At the start of our study, we saw little difference in mortality rates in Democratic and Republican counties. We hope that our findings will open people’s eyes and show the real effect that politics and health policy can have on people’s lives.”
Reference: “Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis” by Haider J Warraich, Pankaj Kumar, Khurram Nasir, Karen E Joynt Maddox and Rishi K Wadhera, 7 June 2022, British Medical Journal.
DOI: 10.1136/bmj-2021-069308
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16 Comments
For pities sake, this is just rhetoric for politics and “internet clout.”
Even as a democrat myself, I acknowledge the nuance that must be accounted for when addressing things like mortality and lifestyle. Republicans are typically independently driven, prefer responsibility/security/commitment over spontaneity, and often respect the individual while devaluing larger systems.
Meanwhile, I’m more community driven, prefer spontaneity over commitment/responsibility, and prefer effective systems, even if it makes some individuals unhappy.
We both have valid perspectives. However, Republicans push harder to shape outcomes for themselves from my experience. I don’t have the same gumption to be self-sufficient and all on my own. I LIKE delegating tasks to others who may be better suited for it. I LIKE not having to worry about maintaining a house. That doesn’t mean my way is “better” than them. If anything I recognize the risk we run in becoming too interdependent. Catastrophic system failure hits groups *way* harder than self-sufficient individuals, so it’s a trade-off.
TLDR: Democrats are becoming risk-averse. One could argue Republicans are now taking the risks that the Democrat party used to. “The authors did not study the effect of flipping political environments” alone should have invalidated this whole venture. Such understanding should help paint a clearer (and less jaded) picture… Why even publish this?
But then again, maybe that’s why this is currently the only comment.
Urban areas, particularly the east and west coasts, tend to be more liberal, with higher membership in the Democrat party. Urbanites typically have better access to health care, whatever their income, than those living in the rural “flyover” interior. Most rural areas have difficulty attracting and holding medical workers, and large medical providers like Kaiser-Permanente discriminate against rural populations by charging them higher premiums, even when patients are willing to make a long drive for care.
However, the study is seriously flawed because by using the dominance of a particular political party, rather than party affiliation (if any) of the deceased, the correlation is one step removed from the assumed relationship being reported. Additionally, other causes of death associated with rural living, such as suicide and farm machinery accidents, may not be dominant in the overall mortality, but they may be common enough to account for a 10% difference.
It is a poorly designed study with just the hint of an odor of bias.
Duh, Republicans are older… Remember the old adage? “If you’re not liberal at 25 you have no heart. If you’re not a conservative at 40 you have no brain.”
No, Virginia. Democrats don’t morf into republicans when they get old, and they certianly don’t move to red counties when they get old. Really. Trust me on this one.
As the article says, the data was adjusted for age.
As the article says – mortality rates were adjusted for age.
As the article says – the mortality rates were adjusted for age.
We have indeed reached the zenith of tabloid news and pseudoscience. How ignorant to push something like this with no correlation or causation, more fear-mongering, and media bias. You will die if you vote Republican.
So, if I start voting Democrat, I’ll live longer?
Who paid you write this?
And who do you think is going to believe this tripe?
Let’s see…oooh it came from a “science” publication, so it’s got to be true!
Could you write instead about something that is NOT pushing your agenda? But then, you’d lose your funding…..
Hmmmm….
But it is true though, Republications have a long history of taking away healthcare and social services. That in its self will lead to increased mortality, the flip side of the coin is democrats have always gone in for increased health care esp to the poor, increased social services AKA what republicans call welfare, its why they have lower mortality. Its only common sense if you are providing people with health care , screenings, access to food, and other programs they are going to be able to cure something early, or prevent it altogether.
It is a sad fact in this country that health and politics walk hand and hand, and yet the people that benefit from these programs the most are the poor white rural communities that vote against their own best interests. And the ironic thing is these poor whites from places like Kentucky, WV etc, are the ones getting food stamps and welfare from the legislation the democrats passed, but voting republican to try and oust the only party that is helping them. Its moronically ironic because in the end when the dems are gone, all their food stamps welfare ssi health care will be gone also. Because its their own party that wants to abolish it.
“Our study suggests that the mortality gap is a modern phenomenon, not an inevitability,” said Warraich. “At the start of our study, we saw little difference in mortality rates in Democratic and Republican counties.” AND, this study concluded before the pandemic in which there was a distinct difference in mortality numbers. The next step in the scientific process is to suggest possible mechanisms behind these differences and then to carry out studies to prove or refute them. If, as a poster above suggested, the evidence show the disparity is related to farm accidents, then there it is. If it’s diabetes, smoking, heart disease, etc, then why? Inadequacies of rural access to quality or timely health care? Failure of states to expand Medicaid? Pollution? You then have to do studies to sort those out. Blaming the scientists for not having completed those studies as yet is like blaming a guy for yelling “FIRE” while he’s trying to find a way into a burning building.
I take this research is a absolute nonsense -has politics encroached into science. Mortality rates depend on numerous factors just not between Democrats and Republicans. This is a complete fabrication. If you dislike someone there are other ways – not instill fear
I too have noticed a connection between many repulicans distain of a healthy lifestyle and medical advice like get a COVID vacine and their unhealthy lifestyle choices like smoking, overeating,not working out. Trump is a role model for anti health .There distain for following a healthy lifestyle is redefined as their need for personal freedom . That lead many around them to get sick when they refused mask mandates.
Not exactly, Karen, but nice try.
How about this: Republicans have to put up with false accusations like yours, based in widespread deliberate manufactured ignorance as the one and only narrative, which has a negative impact on psychological and physical health. Those who promote or enable such toxic narratives lack empathy and conscience, therefore they go on their merry little way feeling like they have “won” by displacing their very own negative characteristics onto innocent people they don’t even know for yet another day, feeling smug.
Try doing same study post covid post jab. Also
‘White privilege ‘ ( i.e. all responsibility no support) and anti male created society , dem crime on republican citizens, so many reasons even tho this study is beyond flawed.
The article has an unfortunate headline that implies individuals not demographic areas as focused on in the study.
A map of the US showing color coded red counties and blue counties will look overwhelmingly red. Most of our land area is rural. Most rural counties are red. Most rural counties have longer distances and time commitments to travel for health care, and farther than that for advanced care specialists.
Adjusting for age is good.
Adjusting for available, timely, affordable healthcare would be good additions. Perhaps seeing available as including open times when the population can get there without losing income would help us see the big picture.