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.”
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 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.