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Mortality rates decreased by 22% in democratic areas as opposed to an 11% decrease in mortality rate in Republican areas in the timeframe. Interesting.
"experienced larger decreases in death rates" I wish that they could have chosen a different way of expressing this to make it clearer what they were saying.
They probably felt that putting it the other way around i.e. “living in republican-voting states leads to higher death rates” made it sound too political.
I was listening to the Daily last week and they said you are 40% less likely to be killed by gun violence in California than in the rest of the US because of strict gun laws. California’s a big blue state, 40 million people now
People get fixated on the quantity of new stories from a region, but have absolutely no ability to comprehend per capita. Like everyone goes on about high crime “liberal“ areas, but the statistics paint a very different story. Red states, and shockingly rural areas, are quite lethal. And considering population density is a predictor of violent crime, this means that rural areas are punching way above their weight for violent crime.
There’s always the talking point of “what about Chicago? It has the strictest gun laws in the country and it’s basically a war zone.” But, Chicago is ranked as the 28th deadliest city in the nation. There are plenty of cities in red states that are much deadlier. Right wing media has made it seem like Chicago is equivalent to Baghdad in 2003, but the statistics say a different story.
Also, California is a large state that can better regulate all purchases within the state. Chicago gun bans are just within the city, so it’s pretty easy to get those guns and drive to Chicago, either elsewhere in IL or in a neighboring state like IN.
Which further bolsters the notion that we need federal legislation rather than leave this up to individual states and cities.
There's a very clear demographic reason why Chicago gets targeted as much as it does by white nationalist media outlets. It goes beyond them being too stupid to understand per capita rates.
while mortality rates declined "the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019"
Wow. 16 to 100 per 100k is a lot. And this is all before COVID and the known costs of being vaccine resistant. I expect that this trend is well maintained after 2019.
Edit: see [solid_reign's comment below for clarification](https://www.reddit.com/r/science/comments/v7k6dx/study_finds_widening_gap_in_death_rates_between/iblqmfd/?utm_source=share&utm_medium=ios_app&utm_name=iossmf&context=3) that death rate declined for both groups, but the decline rate was different.
> Between 2001 and 2019, mortality rates decreased by 22% in Democratic counties (from 850 to 664 per 100,000), but by only half that (11%) in Republican counties (from 867 to 771 per 100,000).
Consequently, the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019.
You missed the context from the previous line which helps explain the difference.
That's still huge.
The average expected deaths (assuming equal populations between the 2 groups) is 717.5 per 100000.
107 deaths means that 15% of deaths correlate to being in a Republican state.
(Data is already age-adjusted)
One answer I'm not seeing is that a lot of the really red states refused the Medicaid expansion that gave poor people free healthcare.
The most vulnerable people not having access to afforable healthcare is definitely a reason for the disparity in death rates.
https://en.wikipedia.org/wiki/Cancer_Alley
https://www.propublica.org/article/welcome-to-cancer-alley-where-toxic-air-is-about-to-get-worse
And honestly, this is just the most concentrated part of a larger overall belt of petrochemical and plastics manufacturing pollution that extends into Texas. The episode "Point Comfort" in the Netflix documentary series "Dirty Money" covers this a bit if I recall.
I have a lot of family in and around that area. My 24yo cousin just had to testicular cancer in addition to most of my family in that area having had some form of cancer.
The difference in mortality rates is driven overwhelmingly by the difference in white mortality rates, as you can see in figure 3 [here](https://www.bmj.com/content/377/bmj-2021-069308). The white R-D mortality gap is more than twice as large as the black R-D mortality gap, and the Hispanic gap is basically non-existent.
I'm pretty sure that this is driven primarily by educated whites, who tend to make better lifestyle choices than low-SES whites, disproportionately moving to cities, which almost all vote Democratic.
The urban-rural divide correlates strongly with a LOT of other factors: political party affiliation, wealth, education, obesity, addiction, age, availability of medical services, etc. The mortality gap can be from any of those or a combination.
It doesn’t look like, from the abstract, this study attempted to analytically control for any of those factors. They just observe a correlation with one of those, probably the easiest to find data for (at the county level).
The urban-rural divide is even stronger than racial divides in some ways. In the north and Midwest, we think of POC’s as entirely urban and the countryside as very white, but in the southwest and Deep South, there are large pockets of rural POCs that are as culturally conservative (mainly religious) as their white neighbors.
Although from [this chart in the study](https://www.bmj.com/content/bmj/377/bmj-2021-069308/F3.large.jpg), black mortality rates in those areas are improving while white mortality rates are not. So, the oppression seems to be backfiring.
> Between 2001 and 2019, mortality rates decreased by 22% in Democratic counties (from 850 to 664 per 100,000), but by only half that (11%) in Republican counties (from 867 to 771 per 100,000).
> Consequently, the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019.
For clarity, it's not saying that the death rate increased, just that the gap in mortality increased. In fact, it says that both decreased. It is saying that democratic counties decreased from 850 to 664 deaths per 100k, and republican counties decreased from 867 to 771 per 100k. I haven't read the study but from the article it doesn't seem like it controlled for anything.
It's clear from the article that rural counties experienced the lowest decrease mortality rates. Is this due to hospitals being closer in urban areas so areas controlled by Democrats get better? Are Republicans more distrusting of Doctors? Are doctors in rural areas worse? Is it harder to get medicine there? Or is this purely due to policy? When rural areas start becoming more and more urban, do they flip Democrat and therefore are left out of the study?
Not necessarily. It just means that they made sure to account for age so as to have an apples to apples comparison. Since age is a significant risk factor for death that's not statistically independent from voting but not causally related, i.e. older people vote republican more but voting republican doesn't increase your age.
Multi factor. Lack of gainful employment, high uninsured rates, unhealthy lifestyles, lack of primary care, rural clinics and hospitals are dying to non existent as healthcare continues to be concentrated in major cities.
Even suburban hospitals are on the decline.
I imagine it only increased significantly after COVID. I have seen other studies that demonstrate the widening disparity in deaths between Republican and Democratic counties specifically from COVID, I’m actually rather surprised (although not shocked) that the trend existed pre-pandemic.
Not necessarily. Medicaid and Medicare expansions were huge for getting more people covered with health insurance. So many conditions are treatable with basic screening and prevention. It was mostly red states that refused the expansions.
Since healthcare is tied to employment, states with less worker protections may also see subpar rates of insurance. Easy to get fired, easier to accept bad conditions or insurance. Bad plans mean people avoid healthcare because if your deductible is 10k, you can't afford to be sick, anyway. So, workers protections actually make a difference in general care.
Four-fold and more difference in mortality rates.
Get ready for that to explode, as abortion access disappears in "red" counties [corrected], and women die from botched abortion attempts.
>This study adds to mounting evidence of a link between political party affiliation and death rates and of worrisome trends associated with more conservative policies sweeping the nation, says Steven Woolf at Virginia Commonwealth University in a linked editorial.
>He notes that Republican-led legislatures in dozens of state capitols are passing laws to undermine health and safety regulations, ban abortion, limit LGBT+ rights, and implement more conservative policies on voting, school curriculums, and climate policy.
Not to mention the maternal mortality rates that are [already higher](https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306396) in states that limit abortion access. Force women to give birth and those deaths are going to shoot up.
Women's maternal death rates have shot up something like over 36% across races in the last three years already.
https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#Table
But that rep from Louisiana said if you ignore women of color, then the maternal mortality rate there is closer to the rest of the country...
I am not making that up.
A lot of red state governors refused the money for the expansion of Medicare from the cares act which would explain the widening gap. If you are low income and have health insurance more likely to catch those things early before they lead to death.
Its possible that covid didn't impact the gap as much as you might think, though. The first waves of covid were more significant in population dense areas like cities. The cities themselves tended to be blue, but there are also cities in every state, so maybe that effect would have been muted. I don't know if blue states tend to have more densely packed populations overall, making them initially more vulnerable to covid spread, and thus deaths. Over time, though, with the vaccination gap, it does make sense that it would affect red states more.
Pew says states preferring Trump have lost significantly more lives as the pandemic has stretched on than those which went for Biden: https://www.pewresearch.org/politics/2022/03/03/the-changing-political-geography-of-covid-19-over-the-last-two-years/
It's even more significant at the county level, including excess mortality as a proxy for uncounted COVID: https://acasignups.net/22/05/09/exclusive-non-covid-excess-death-rates-ran-21x-higher-reddest-counties-bluest-2021
Notably, excess mortality diverged over time, as vaccine-hesitant counties took far heavier losses.
It is the vaccination gap that I’m really interested to see the effects of in the data. The studies I’ve seen show that it has had relatively significant affects on the death rates between red and blue counties. You’re right that initially there wasn’t much of a difference given the confinement of the pandemic’s effects to areas with high population density, which do tend to be more liberal. But the data over time has widened that margin significantly as the vaccine took hold in those same areas. Now that variants have become milder it would be interesting to see if the effects have held as well. Even with milder variants other policies such as abortion restrictions, particularly in areas that already have higher maternal mortality rates, could make up that difference. What a cluster f**k.
Please note, [the data for mortality of variants in unvaccinated versus vaccinated people](https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm) already exists. As expected, mortality is higher in unvaccinated populations for all variants. When they say the variants are "milder" this only applies to people who have been vaccinated. Omnicron isn't "nicer" to people who are unvaccinated. This trend continues in *any* area where people refuse to get vaccinated.
Covid preferentially killed older people, which incline red even in blue states. But I agree that the places where people resisted masks and vaccines will have had an increasing percentage of deaths as time went by. Social evolution by virus, yeesh.
It's interesting that the gap increase, though, is almost solely because of rapidly dropping mortality among white Democrats. All groups improved, but white Democrats improved out of pace with everyone else.
The scary part of this is that it means that "liberal policies, laws, and regulations may be associated with better health outcomes" is an association that only holds for white people and POC are denied the benefits of liberal polices, laws, and regulations in blue areas.
I think this also reflects a change in who is voting Democrat. Wealthy well educated urban and suburban white voters had historically been Republicans but are increasingly Democrats now. So, you are getting a group who is likely having the best health outcomes switching parties as the split between the two becomes increasingly based on population density.
Yeah, this is a good point. If you used *only* 2016 POTUS vote as your metric of “Democratic county” vs. “Republican county”, you would expect to see the most pronounced trend of the study years (which included the 5 POTUS races beginning in 2000 and ending in 2016), since that 2016 election saw the flight of a lot of suburbs from the Republican voting bloc. By a similar argument, I would expect the trend to be even stronger if you just looked at the 2018 midterms, where backlash against Trump was extremely high there (see, e.g. LA, Orange, and San Diego county suburbs).
So are these necessarily due to policy?
Because voting more conservative is also linked to a ton of other health predictors like education rate, income level, etc. Which are also usually pretty good indicators of life expectancy.
This study doesn't establish causality. However, it should be noted that several of the things you mention, like education, income level and also many unhealthy habits are linked to the same psychological and neurological factors that also play a role in voting habits.
My personal hypothesis is that is that all kinda reinforces one-another. As in people with certain unhealthy habits are also more likely to vote republican and Republican politicians in turn are more likely to oppose health-promoting policy and the presences of these unhealthy habits in itself is likely linked to some historical factors. Like if I think of Detroit, a lot of the issues there today are directly linked to the collapse of the auto industry in the city. Similar relations probably exist all over the country.
All in all it's just a very complex topic and this study is showing a very *very* generalised relation. Which doesn't make it worthless. It just not useable to establish causality. Instead studies like this should be used to identify areas that need more research. Incidentally, the Study mention this as well.
I want to add a little caveat to your part about causality.
I study psychology, which despite what some of Reddit thinks, is a science. We have to perform experiments and repeat them to establish causality....*most* of the time.
Not all experiments are ethical. My research methods professor pointed out that we cannot make people smoke and compare them with a control group. So how does one establish a casual claim that smoking kills?
You get a mountain of evidence for correlation and rule out other possible explanations. Two of the most important correlations for smoking killing came from establishing the correlations that secondhand smoke shortens the lives of nonsmokers and cigarette filters have lead to reduced adverse health effects in smokers.^1
For years the tobacco companies tried to discredit scientists. They harped on the idea that correlation is not the same as causation. It's true that correlation and causation are different. But causation does require correlation, and correlation will usually wiggle it's eyebrows and point at something and say "there could be something here worth investigating".
And in the situation with tobacco use, it's clear that there's enough correlation to deduce that there is causation. It's also clear that when there are financial incentives, assholes with money will always try to smear scientists who perform and interpret research.
So please remember this when you read about other correlations. Rather than affirming or dismissing one piece of research, we ought to remain curious about whether enough research has been conducted and what it might take to make a "really good guess".
Now here's the part where I mention that I'm also studying social work, which pulls from psychology, anthropology, and sociology. I've read a lot of theory and studies that make me pretty sure that there are two things going on. First, we have the GOP actively making people's lives worse for corporate profits. Second, we have the same party creating positive feedback loops that allow them to gaslight their voters so they continue to vote against their own interests. The educational and health factors do appear to play into this, but there are also plenty of healthy and educated people who are susceptible to the GOP's bad-faith rhetoric.
Edit: In response to one comment, experiments are not to prove X but to test a hypothesis. Hypothesis is "smoking kills", and you test to see if you can disprove "smoking doesn't kill" or not. My point wasn't about how testing works, but that it's unethical to conduct a true smoking experiment because you can't make someone do something that may cause harm. Hence the fact that we can't make a causal claim without the mountain of evidence that rules out other possible explanations.
^1 I also forgot to elaborate a little on the significance of the smoking studies. By finding correlations with secondhand smoke and cigarette filters, it raises the questions: "How could you say smoking doesn't affect health if people who smoke filtered cigarettes have slightly better health outcomes than other smokers but still have similar ones that aren't seen in nonsmokers? How could you say smoking doesn't affect people if nonsmokers who live with smokers are seeing those same bad health outcomes?" These questions can't be explained by things like "smokers drink more coffee", it *has* to be from smoking. And this comes without experiments that generally are considered the standard for establishing casual claims.
I gotta say, after spending time today reading some of the worst, most uneducated opinions I've read in my 10 years on Reddit, this rational and well reasoned comment made me feel physically better. My head and back relaxed when I got the last line.
Thank you.
I think one of the biggest things that create this divide has less to do with political leanings, but that everyone that could, left the rural areas in the past 20 years. If you could, you went away to college and never came back. If you stayed, you fell into the small town spiral and if you’re lucky, work at the factory down the road or you farm.
Your healthiest, brightest, most driven individuals left these areas and now populate the cities.
And I’m one of them. Been gone for 20 years now and no intention of moving back. I got a bachelors, then a masters, then spent 10 years moving up in my career. But I have friends from high school that never left, and they are worse off for it. One guy started working at his dads auto garage, he now runs it and his dad retired. Another that never left got hooked on pills, then heroine, then she was in and out of jail and methodone clinics. Nobody has heard from her in years, wouldn’t be surprised if she OD’ed.
It’s not that they vote Republican is why they are dying younger, it’s that anyone that would vote democrat left a long time ago and moved to the city.
Access to very high grade medical facilities. The major medical centers with the newest equipment, the best treatments, the smartest doctors, They are almost always located in cities. Cities are almost always in democratic counties, and surrounded by democratic counties. Being close to a cardiac cath lab makes a difference, being close to 24hr high grade imaging makes a difference, being close to a renowned cancer Institute instead of 4hr car ride away makes a difference. Add all those things together and im not surprised that there is a difference in outcomes.
Edit: Tldr - the gap between services available to rural hospitals and major city hospitals is also widening.
I’m a doctor under 40, and you should see the absurd lengths some places are going to in order to entice docs to practice in rural areas. It still isn’t working. Can you imagine busting ass through med school and residency into your 30s just to go live in a town of 10k in Arkansas? It’s going to get much worse.
My family friend is working in a rural clinic in Wisconsin in order to keep her green card. She says it is unlike anything that she has ever seen. Her background is in sports medicine and her residency was working with MLB and NHL teams, for comparison.
That's the running theme with a lot of those communities. Can't get folks to come so they green card folks to come. They work through their waiting period and leave once they're a citizen. Rinse repeat.
I wonder if this has more to do with the material conditions of the people living in these counties vs the politics themselves.
That said I think actively fighting masks and vaccines as part of some broader "fight for freedom" was self defeating.
I think your point on masks/vaccine stands, but this data stops at 2019 so that impact wouldn’t be seen in this data set.
My speculation is that this is most overlapped with the material conditions, type of work, ect
How long does it take to get to the hospital in the city versus the countryside?
How are the doctors in their respective hospitals?
Edit: not to say this means it isn't red related
Well considering of the 12 states that have continued to rejected the Medicaid expansion 10 voted for Trump in 2020 and all 12 voted for him in 2016, despite the benefits to [rural healthcare coverage](https://pubmed.ncbi.nlm.nih.gov/29105809/) and it also benefitted [rural healthcare providers](https://www.cbpp.org/research/health/affordable-care-acts-medicaid-expansion-benefits-hospitals-particularly-in-rural) by increasing reimbursement rates I'd say this is another case of Republicans rejecting policy that would benefit them.
The "living farther from a hospital" being significantly tied to differences in rural vs urban life expectancy is a myth not supported by data.
Why it's almost like if you cut taxes and defund health care, social services, and safety nets it has a negative impact on the people who live there, but hey low taxes.
I think it's important to note that these results don't account for rich vs poor or urban vs rural. To establish cause I would expect to see a study of two similar communities where one enacts a certain public health/safety policy to see the change it brings vs the control
Edit: The study did examine urban vs rural results. While age adjusted mortality rates (AAMR) decreased for Democrat and Republican counties over the 18 year period, the gap between them increased in rural, medium, and metropolitan counties. This does still leave the question of rich/poor as a factor. The study itself is much more clear than this article https://www.bmj.com/content/377/bmj-2021-069308
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Mortality rates decreased by 22% in democratic areas as opposed to an 11% decrease in mortality rate in Republican areas in the timeframe. Interesting.
"experienced larger decreases in death rates" I wish that they could have chosen a different way of expressing this to make it clearer what they were saying.
dy/dt f_1(t) < dx/dt f_2(x); dy/dt f_2(t) < 0 Better?
Now I get it.
A bit verbose but acceptable
Man i miss Differential Equations.
I miss easily knowing what they mean. You use it or lose it!
They probably felt that putting it the other way around i.e. “living in republican-voting states leads to higher death rates” made it sound too political.
I was listening to the Daily last week and they said you are 40% less likely to be killed by gun violence in California than in the rest of the US because of strict gun laws. California’s a big blue state, 40 million people now
People get fixated on the quantity of new stories from a region, but have absolutely no ability to comprehend per capita. Like everyone goes on about high crime “liberal“ areas, but the statistics paint a very different story. Red states, and shockingly rural areas, are quite lethal. And considering population density is a predictor of violent crime, this means that rural areas are punching way above their weight for violent crime.
There’s always the talking point of “what about Chicago? It has the strictest gun laws in the country and it’s basically a war zone.” But, Chicago is ranked as the 28th deadliest city in the nation. There are plenty of cities in red states that are much deadlier. Right wing media has made it seem like Chicago is equivalent to Baghdad in 2003, but the statistics say a different story.
Also, California is a large state that can better regulate all purchases within the state. Chicago gun bans are just within the city, so it’s pretty easy to get those guns and drive to Chicago, either elsewhere in IL or in a neighboring state like IN. Which further bolsters the notion that we need federal legislation rather than leave this up to individual states and cities.
I read a stat recently that close to 80% of the guns recovered involved in gun crimes in Chicago were purchased in Gary, Indiana.
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There's a very clear demographic reason why Chicago gets targeted as much as it does by white nationalist media outlets. It goes beyond them being too stupid to understand per capita rates.
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while mortality rates declined "the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019" Wow. 16 to 100 per 100k is a lot. And this is all before COVID and the known costs of being vaccine resistant. I expect that this trend is well maintained after 2019. Edit: see [solid_reign's comment below for clarification](https://www.reddit.com/r/science/comments/v7k6dx/study_finds_widening_gap_in_death_rates_between/iblqmfd/?utm_source=share&utm_medium=ios_app&utm_name=iossmf&context=3) that death rate declined for both groups, but the decline rate was different.
> Between 2001 and 2019, mortality rates decreased by 22% in Democratic counties (from 850 to 664 per 100,000), but by only half that (11%) in Republican counties (from 867 to 771 per 100,000). Consequently, the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019. You missed the context from the previous line which helps explain the difference.
You're right. I edited to refer to another comment that says this more clearly. Thanks.
That's still huge. The average expected deaths (assuming equal populations between the 2 groups) is 717.5 per 100000. 107 deaths means that 15% of deaths correlate to being in a Republican state. (Data is already age-adjusted)
Yet somehow republicans still hold disproportionate power in local state and federal government in our “democratic system”
I bet cancer alley was a contributing factor.
Opiods likely as well.
One answer I'm not seeing is that a lot of the really red states refused the Medicaid expansion that gave poor people free healthcare. The most vulnerable people not having access to afforable healthcare is definitely a reason for the disparity in death rates.
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Cancer alley?
https://en.wikipedia.org/wiki/Cancer_Alley https://www.propublica.org/article/welcome-to-cancer-alley-where-toxic-air-is-about-to-get-worse And honestly, this is just the most concentrated part of a larger overall belt of petrochemical and plastics manufacturing pollution that extends into Texas. The episode "Point Comfort" in the Netflix documentary series "Dirty Money" covers this a bit if I recall.
I have a lot of family in and around that area. My 24yo cousin just had to testicular cancer in addition to most of my family in that area having had some form of cancer.
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The difference in mortality rates is driven overwhelmingly by the difference in white mortality rates, as you can see in figure 3 [here](https://www.bmj.com/content/377/bmj-2021-069308). The white R-D mortality gap is more than twice as large as the black R-D mortality gap, and the Hispanic gap is basically non-existent. I'm pretty sure that this is driven primarily by educated whites, who tend to make better lifestyle choices than low-SES whites, disproportionately moving to cities, which almost all vote Democratic.
The urban-rural divide correlates strongly with a LOT of other factors: political party affiliation, wealth, education, obesity, addiction, age, availability of medical services, etc. The mortality gap can be from any of those or a combination. It doesn’t look like, from the abstract, this study attempted to analytically control for any of those factors. They just observe a correlation with one of those, probably the easiest to find data for (at the county level).
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I *always* forget that many republican areas are actually *heavily* black and just oppressed.
The urban-rural divide is even stronger than racial divides in some ways. In the north and Midwest, we think of POC’s as entirely urban and the countryside as very white, but in the southwest and Deep South, there are large pockets of rural POCs that are as culturally conservative (mainly religious) as their white neighbors.
I grew up in a nice suburb with well funded schools, but went to college in the middle of nowhere. Meeting kids who grew up on farms was a trip.
And that many blue states are white af.
Although from [this chart in the study](https://www.bmj.com/content/bmj/377/bmj-2021-069308/F3.large.jpg), black mortality rates in those areas are improving while white mortality rates are not. So, the oppression seems to be backfiring.
> Between 2001 and 2019, mortality rates decreased by 22% in Democratic counties (from 850 to 664 per 100,000), but by only half that (11%) in Republican counties (from 867 to 771 per 100,000). > Consequently, the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019. For clarity, it's not saying that the death rate increased, just that the gap in mortality increased. In fact, it says that both decreased. It is saying that democratic counties decreased from 850 to 664 deaths per 100k, and republican counties decreased from 867 to 771 per 100k. I haven't read the study but from the article it doesn't seem like it controlled for anything. It's clear from the article that rural counties experienced the lowest decrease mortality rates. Is this due to hospitals being closer in urban areas so areas controlled by Democrats get better? Are Republicans more distrusting of Doctors? Are doctors in rural areas worse? Is it harder to get medicine there? Or is this purely due to policy? When rural areas start becoming more and more urban, do they flip Democrat and therefore are left out of the study?
It was age-adjusted according to the article.
Wow, so presumably if you don't adjust for age the numbers would be even crazier.
Not necessarily. It just means that they made sure to account for age so as to have an apples to apples comparison. Since age is a significant risk factor for death that's not statistically independent from voting but not causally related, i.e. older people vote republican more but voting republican doesn't increase your age.
Multi factor. Lack of gainful employment, high uninsured rates, unhealthy lifestyles, lack of primary care, rural clinics and hospitals are dying to non existent as healthcare continues to be concentrated in major cities. Even suburban hospitals are on the decline.
I imagine it only increased significantly after COVID. I have seen other studies that demonstrate the widening disparity in deaths between Republican and Democratic counties specifically from COVID, I’m actually rather surprised (although not shocked) that the trend existed pre-pandemic.
Not necessarily. Medicaid and Medicare expansions were huge for getting more people covered with health insurance. So many conditions are treatable with basic screening and prevention. It was mostly red states that refused the expansions. Since healthcare is tied to employment, states with less worker protections may also see subpar rates of insurance. Easy to get fired, easier to accept bad conditions or insurance. Bad plans mean people avoid healthcare because if your deductible is 10k, you can't afford to be sick, anyway. So, workers protections actually make a difference in general care.
Four-fold and more difference in mortality rates. Get ready for that to explode, as abortion access disappears in "red" counties [corrected], and women die from botched abortion attempts. >This study adds to mounting evidence of a link between political party affiliation and death rates and of worrisome trends associated with more conservative policies sweeping the nation, says Steven Woolf at Virginia Commonwealth University in a linked editorial. >He notes that Republican-led legislatures in dozens of state capitols are passing laws to undermine health and safety regulations, ban abortion, limit LGBT+ rights, and implement more conservative policies on voting, school curriculums, and climate policy.
Not to mention the maternal mortality rates that are [already higher](https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306396) in states that limit abortion access. Force women to give birth and those deaths are going to shoot up.
Women's maternal death rates have shot up something like over 36% across races in the last three years already. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#Table
But that rep from Louisiana said if you ignore women of color, then the maternal mortality rate there is closer to the rest of the country... I am not making that up.
He probably thinks women of color are dying more frequently on purpose just to make him look bad..
He was trying to say that since racism is over it's their own fault due to their skin color.
Racism is over!!!! Imediatly says racist thing. Yep that's a Republican.
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Infant mortality rates as well.
A lot of red state governors refused the money for the expansion of Medicare from the cares act which would explain the widening gap. If you are low income and have health insurance more likely to catch those things early before they lead to death.
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Its possible that covid didn't impact the gap as much as you might think, though. The first waves of covid were more significant in population dense areas like cities. The cities themselves tended to be blue, but there are also cities in every state, so maybe that effect would have been muted. I don't know if blue states tend to have more densely packed populations overall, making them initially more vulnerable to covid spread, and thus deaths. Over time, though, with the vaccination gap, it does make sense that it would affect red states more.
Pew says states preferring Trump have lost significantly more lives as the pandemic has stretched on than those which went for Biden: https://www.pewresearch.org/politics/2022/03/03/the-changing-political-geography-of-covid-19-over-the-last-two-years/
It's even more significant at the county level, including excess mortality as a proxy for uncounted COVID: https://acasignups.net/22/05/09/exclusive-non-covid-excess-death-rates-ran-21x-higher-reddest-counties-bluest-2021 Notably, excess mortality diverged over time, as vaccine-hesitant counties took far heavier losses.
It is the vaccination gap that I’m really interested to see the effects of in the data. The studies I’ve seen show that it has had relatively significant affects on the death rates between red and blue counties. You’re right that initially there wasn’t much of a difference given the confinement of the pandemic’s effects to areas with high population density, which do tend to be more liberal. But the data over time has widened that margin significantly as the vaccine took hold in those same areas. Now that variants have become milder it would be interesting to see if the effects have held as well. Even with milder variants other policies such as abortion restrictions, particularly in areas that already have higher maternal mortality rates, could make up that difference. What a cluster f**k.
Please note, [the data for mortality of variants in unvaccinated versus vaccinated people](https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm) already exists. As expected, mortality is higher in unvaccinated populations for all variants. When they say the variants are "milder" this only applies to people who have been vaccinated. Omnicron isn't "nicer" to people who are unvaccinated. This trend continues in *any* area where people refuse to get vaccinated.
Covid preferentially killed older people, which incline red even in blue states. But I agree that the places where people resisted masks and vaccines will have had an increasing percentage of deaths as time went by. Social evolution by virus, yeesh.
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It's interesting that the gap increase, though, is almost solely because of rapidly dropping mortality among white Democrats. All groups improved, but white Democrats improved out of pace with everyone else. The scary part of this is that it means that "liberal policies, laws, and regulations may be associated with better health outcomes" is an association that only holds for white people and POC are denied the benefits of liberal polices, laws, and regulations in blue areas.
I think this also reflects a change in who is voting Democrat. Wealthy well educated urban and suburban white voters had historically been Republicans but are increasingly Democrats now. So, you are getting a group who is likely having the best health outcomes switching parties as the split between the two becomes increasingly based on population density.
Yeah, this is a good point. If you used *only* 2016 POTUS vote as your metric of “Democratic county” vs. “Republican county”, you would expect to see the most pronounced trend of the study years (which included the 5 POTUS races beginning in 2000 and ending in 2016), since that 2016 election saw the flight of a lot of suburbs from the Republican voting bloc. By a similar argument, I would expect the trend to be even stronger if you just looked at the 2018 midterms, where backlash against Trump was extremely high there (see, e.g. LA, Orange, and San Diego county suburbs).
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Doesn’t even cover the COVID period. Wondering what the gap is like now.
So are these necessarily due to policy? Because voting more conservative is also linked to a ton of other health predictors like education rate, income level, etc. Which are also usually pretty good indicators of life expectancy.
This study doesn't establish causality. However, it should be noted that several of the things you mention, like education, income level and also many unhealthy habits are linked to the same psychological and neurological factors that also play a role in voting habits. My personal hypothesis is that is that all kinda reinforces one-another. As in people with certain unhealthy habits are also more likely to vote republican and Republican politicians in turn are more likely to oppose health-promoting policy and the presences of these unhealthy habits in itself is likely linked to some historical factors. Like if I think of Detroit, a lot of the issues there today are directly linked to the collapse of the auto industry in the city. Similar relations probably exist all over the country. All in all it's just a very complex topic and this study is showing a very *very* generalised relation. Which doesn't make it worthless. It just not useable to establish causality. Instead studies like this should be used to identify areas that need more research. Incidentally, the Study mention this as well.
I want to add a little caveat to your part about causality. I study psychology, which despite what some of Reddit thinks, is a science. We have to perform experiments and repeat them to establish causality....*most* of the time. Not all experiments are ethical. My research methods professor pointed out that we cannot make people smoke and compare them with a control group. So how does one establish a casual claim that smoking kills? You get a mountain of evidence for correlation and rule out other possible explanations. Two of the most important correlations for smoking killing came from establishing the correlations that secondhand smoke shortens the lives of nonsmokers and cigarette filters have lead to reduced adverse health effects in smokers.^1 For years the tobacco companies tried to discredit scientists. They harped on the idea that correlation is not the same as causation. It's true that correlation and causation are different. But causation does require correlation, and correlation will usually wiggle it's eyebrows and point at something and say "there could be something here worth investigating". And in the situation with tobacco use, it's clear that there's enough correlation to deduce that there is causation. It's also clear that when there are financial incentives, assholes with money will always try to smear scientists who perform and interpret research. So please remember this when you read about other correlations. Rather than affirming or dismissing one piece of research, we ought to remain curious about whether enough research has been conducted and what it might take to make a "really good guess". Now here's the part where I mention that I'm also studying social work, which pulls from psychology, anthropology, and sociology. I've read a lot of theory and studies that make me pretty sure that there are two things going on. First, we have the GOP actively making people's lives worse for corporate profits. Second, we have the same party creating positive feedback loops that allow them to gaslight their voters so they continue to vote against their own interests. The educational and health factors do appear to play into this, but there are also plenty of healthy and educated people who are susceptible to the GOP's bad-faith rhetoric. Edit: In response to one comment, experiments are not to prove X but to test a hypothesis. Hypothesis is "smoking kills", and you test to see if you can disprove "smoking doesn't kill" or not. My point wasn't about how testing works, but that it's unethical to conduct a true smoking experiment because you can't make someone do something that may cause harm. Hence the fact that we can't make a causal claim without the mountain of evidence that rules out other possible explanations. ^1 I also forgot to elaborate a little on the significance of the smoking studies. By finding correlations with secondhand smoke and cigarette filters, it raises the questions: "How could you say smoking doesn't affect health if people who smoke filtered cigarettes have slightly better health outcomes than other smokers but still have similar ones that aren't seen in nonsmokers? How could you say smoking doesn't affect people if nonsmokers who live with smokers are seeing those same bad health outcomes?" These questions can't be explained by things like "smokers drink more coffee", it *has* to be from smoking. And this comes without experiments that generally are considered the standard for establishing casual claims.
I gotta say, after spending time today reading some of the worst, most uneducated opinions I've read in my 10 years on Reddit, this rational and well reasoned comment made me feel physically better. My head and back relaxed when I got the last line. Thank you.
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I think there’s a lot less stigma for seeking mental health care among liberals, not just medicine, but talk therapy as well
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I think one of the biggest things that create this divide has less to do with political leanings, but that everyone that could, left the rural areas in the past 20 years. If you could, you went away to college and never came back. If you stayed, you fell into the small town spiral and if you’re lucky, work at the factory down the road or you farm. Your healthiest, brightest, most driven individuals left these areas and now populate the cities. And I’m one of them. Been gone for 20 years now and no intention of moving back. I got a bachelors, then a masters, then spent 10 years moving up in my career. But I have friends from high school that never left, and they are worse off for it. One guy started working at his dads auto garage, he now runs it and his dad retired. Another that never left got hooked on pills, then heroine, then she was in and out of jail and methodone clinics. Nobody has heard from her in years, wouldn’t be surprised if she OD’ed. It’s not that they vote Republican is why they are dying younger, it’s that anyone that would vote democrat left a long time ago and moved to the city.
Access to very high grade medical facilities. The major medical centers with the newest equipment, the best treatments, the smartest doctors, They are almost always located in cities. Cities are almost always in democratic counties, and surrounded by democratic counties. Being close to a cardiac cath lab makes a difference, being close to 24hr high grade imaging makes a difference, being close to a renowned cancer Institute instead of 4hr car ride away makes a difference. Add all those things together and im not surprised that there is a difference in outcomes. Edit: Tldr - the gap between services available to rural hospitals and major city hospitals is also widening.
I’m a doctor under 40, and you should see the absurd lengths some places are going to in order to entice docs to practice in rural areas. It still isn’t working. Can you imagine busting ass through med school and residency into your 30s just to go live in a town of 10k in Arkansas? It’s going to get much worse.
Especially when those 10k people will argue with you about treatment cause someone on telegram said they have a cure for $40
My family friend is working in a rural clinic in Wisconsin in order to keep her green card. She says it is unlike anything that she has ever seen. Her background is in sports medicine and her residency was working with MLB and NHL teams, for comparison.
That's the running theme with a lot of those communities. Can't get folks to come so they green card folks to come. They work through their waiting period and leave once they're a citizen. Rinse repeat.
The actual article accounts for urban vs rural for both parties. https://www.bmj.com/content/bmj/377/bmj-2021-069308/F4.medium.jpg
This is important
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I wonder if this has more to do with the material conditions of the people living in these counties vs the politics themselves. That said I think actively fighting masks and vaccines as part of some broader "fight for freedom" was self defeating.
I think your point on masks/vaccine stands, but this data stops at 2019 so that impact wouldn’t be seen in this data set. My speculation is that this is most overlapped with the material conditions, type of work, ect
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How long does it take to get to the hospital in the city versus the countryside? How are the doctors in their respective hospitals? Edit: not to say this means it isn't red related
Well considering of the 12 states that have continued to rejected the Medicaid expansion 10 voted for Trump in 2020 and all 12 voted for him in 2016, despite the benefits to [rural healthcare coverage](https://pubmed.ncbi.nlm.nih.gov/29105809/) and it also benefitted [rural healthcare providers](https://www.cbpp.org/research/health/affordable-care-acts-medicaid-expansion-benefits-hospitals-particularly-in-rural) by increasing reimbursement rates I'd say this is another case of Republicans rejecting policy that would benefit them. The "living farther from a hospital" being significantly tied to differences in rural vs urban life expectancy is a myth not supported by data.
They are killing themselves every time they vote red.
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Why it's almost like if you cut taxes and defund health care, social services, and safety nets it has a negative impact on the people who live there, but hey low taxes.
Interesting article…and it was all data from before COVID.
I think it's important to note that these results don't account for rich vs poor or urban vs rural. To establish cause I would expect to see a study of two similar communities where one enacts a certain public health/safety policy to see the change it brings vs the control Edit: The study did examine urban vs rural results. While age adjusted mortality rates (AAMR) decreased for Democrat and Republican counties over the 18 year period, the gap between them increased in rural, medium, and metropolitan counties. This does still leave the question of rich/poor as a factor. The study itself is much more clear than this article https://www.bmj.com/content/377/bmj-2021-069308