Republican-leaning counties in the U.S. experienced higher rates of premature death even before the start of the COVID-19 pandemic, a study found, and researchers fear politically polarized responses to the virus could widen the gap.
Democratic-voting counties had an overall 15% lower death rate than Republican counties in 2019, up from a 3% difference in 2001, researchers at Harvard-affiliated Brigham and Women’s Hospital in Boston said Tuesday in a study. The research in the BMJ medical journal compared mortality data from U.S. counties based on how they voted in historical presidential and gubernatorial elections.
Attitudes on health-related issues such as abortion and HIV prevention have long tracked along political lines. The study doesn’t include mortality data from the pandemic, which took hold in the U.S. in March 2020. However, the authors say that divisive posturing around virus countermeasures such as vaccines and mask-wearing could mean that the rift will continue to widen.
The pandemic was the first time that politics has become such a salient, identifiable public health issue, Haider Warraich, a physician at Brigham and Women’s and the study’s lead author, said in an interview. “The main implication of our study is that what party environment you live in, or what party ideology you are affiliated with, will have a significant outcome on your health,” he said.
When the study began, rural Democratic counties were slightly worse off than their Republican counterparts, Warraich said. That has since shifted, with Republicans in rural counties seeing the least improvement in mortality rates during the last two decades.
“If you go back to 2001, there was basically no difference in outcomes between Democratic and Republican counties,” he said. “But health and politics have now become so deeply enmeshed.”
Improvements slowed
Advances in medicine, prevention and technology have helped decrease the risk of premature death across the U.S. over the years. After 2008, however, those health improvements slowed to near zero for Republicans.
One explanation, Warraich said, is that in 2010, more Democratic states than Republican states adopted Medicaid expansion for millions of low-income people under the Affordable Care Act. That may have led to lower rates of screening, diagnosis and treatment of disease in uncovered populations, the researchers said.
From 2010 through 2019, Democrats saw a 22% decrease in premature death rates, while Republicans saw just 11%, leading to a mortality gap that’s widened to six times its size in 2001, Warraich said.
Common causes of death like heart disease and cancer have been the driving factors behind the difference in health outcomes. But unintentional injury and suicide also contributed to the growing mortality gap, the study found.
Both men and women living in Democratic counties had better health overall compared to Republicans, experiencing fewer premature deaths over the years from things like diabetes, flu, pneumonia and kidney disease. Those disparities likely reflect the patchwork application of health policies along partisan lines, the authors say.
Life expectancy
The new findings build on previous studies showing Republican counties in the U.S. have worse health outcomes, such as fewer gains in life expectancy and higher rates of opioid use, the researchers noted. Other studies have shown an association between conservative state policies, such as restrictions on abortion and looser gun laws, and shorter life expectancy for women.
Though completed before the pandemic, the authors are concerned about what the study could mean for COVID-19, which has sparked politically linked differences in vaccine uptake, masking, and trust in health officials. Average COVID deaths per 100,000 people is slightly higher for states with Republican governors than those with Democratic governors, according to an analysis of data from the Centers for Disease Control and Prevention. But Warraich said it’s likely there will be a “long tail” to the pandemic death toll, making the mortality gap between Republicans and Democrats grow.
“I hope that people will look at these data and really find some common ground,” Warraich said. “This gap is not inevitable.”
