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U.S. death rates show how politics are affecting public health
- jka 4y ago"In this study, in which we linked U.S. mortality and election data from 2001 to 2019, people in counties that voted for Republican presidential candidates were more like to die prematurely than those in counties that voted for Democratic candidates, and the gap has grown sixfold over the last two decades. We found similar results when we looked only at counties that voted for one party’s candidate throughout that period, as well as when we used state election data for governors." And a link to the paper ("Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis") that the article describes: https://www.bmj.com/content/377/bmj-2021-069308 https://www.bmj.com/content/377/bmj-2021-069308
- robotblake 4y agoOf specific note I found this quote very alarming > There was no single cause of death driving this lethal wedge: The death rate due to all 10 of the most common causes of death has widened between Republican and Democratic areas.
- esotericimpl 4y agoThis shouldn't be surprising 70% of the GDP output of the USA are from counties won by Biden. Wealthier people live longer than poor people. https://www.brookings.edu/blog/the-avenue/2020/11/09/biden-voting-counties-equal-70-of-americas-economy-what-does-this-mean-for-the-nations-political-economic-divide/ https://www.brookings.edu/blog/the-avenue/2020/11/09/biden-v... The current republican party provides a hate machine with no actual solutions other than tax cuts for the rich and culture war for the rubes. All that is left for the Red counties is anger and despair delivered nightly via Fox news and the right wing lie machine.
- mensetmanusman 4y agoA large percentage of the 70% GDP is the <1% megacorps/billionaires though, so it’s a complicated picture. Cities have huge inequality.
- Mountain_Skies 4y agoSurely the solution is for Democrats to force themselves on Republicans, who should accept this imposition of control for their own good.
- deleted 4y ago[deleted]
- otter-rock 4y agoThe author specifically said that the solution is to find a less partisan approach. Who are you arguing with?
- wolverine876 4y agoWith the imaginary Democrats and liberals strawpeople that the reactionary media tells everyone about (tip: meet some actual Democrats and liberals; they have nothing to do with that BS).
- mistrial9 4y agoIsn't this basic demagoguery 101 -- attach huge social outcomes to the victory or loss of one political party?
- Valgrim 4y agoDemagoguery implies an appeal to emotion rather than reason. The argument presented in this articles stems from reason and is an analysis of real, verifiable data, so I'd say no.
- ceeplusplus 4y agoThe article tries to come to the conclusion that correlation equals causation. The title reads "A growing gap in premature deaths along party lines underscores the collision of politics and public health" which implies politics causes premature deaths. In reality it's more likely that the average Republican voter skews both lower income and rural which is the true causation of deaths.
- Spivak 4y agoUnless you're arguing that the typical Republican voter is skewing ruraler and poorer over time such a theory doesn't explain why the gap is growing.
- ceeplusplus 4y agoI think that's a valid argument to be made. Stats have shown the Republican party has become more blue collar over time [1] and that white collar workers are trending left over time [2]. This would explain why the gap is growing: blue collar workers make less and sacrifice more of their health on the job than white collar workers. Blue collar workers also generally don't live in cities, because factories and industry aren't located in cities. [1] https://www.nbcnews.com/politics/meet-the-press/gop-rapidly-becoming-blue-collar-party-here-s-what-means-n1258468 https://www.nbcnews.com/politics/meet-the-press/gop-rapidly-... [2] https://www.washingtonpost.com/politics/2022/01/11/democrat-voters-working-class-race/ https://www.washingtonpost.com/politics/2022/01/11/democrat-...
- tokai 4y agoDoesn't this just reflect the class of the average voter of the two parties, ie. measuring the different socio-economic realities? Seems a bit over the top to hitch it all on ‘political environment’. I'm no expert but it feels like these MDs should have gotten a social scientist or two to co-author.
- nr2x 4y agoIt’s access to care after 2008, democratic areas expanded it, republicans didn’t.
- tokai 4y agoSorry I forgot to specify that I commented on the paper mentioned in the start of the second paragraph. That study only looks at voting patterns and mortality. I'm sympathetic to Warraich's position, but its weak that he combines the conclusions of the voter patterns and access-to-care study in an opinion article and not in a peer reviewed paper. Hopefully one is in preparation.
- wolverine876 4y agoHere's the paper: https://www.bmj.com/content/377/bmj-2021-069308 https://www.bmj.com/content/377/bmj-2021-069308
- tzs 4y agoI don't know about this particular study, but others I have seen looked at things at county levels, where they could find counties that differed on voting but were otherwise similar, and found that health outcomes were indeed significantly influenced by party.
- belltaco 4y agoNot really: https://www.usatoday.com/story/news/politics/onpolitics/2016/05/05/donald-trump-average-voter-income-72000-middle-class/83972800/ https://www.usatoday.com/story/news/politics/onpolitics/2016... >In fact, Silver parsed the data to discover the average Trump voter makes $72,000 per year — a middle-class income solidly above the typical American. >As compared with most Americans, Trump’s voters are better off. The median household income of a Trump voter so far in the primaries is about $72,000, based on estimates derived from exit polls and Census Bureau data. >That’s lower than the $91,000 median for Kasich voters. But it’s well above the national median household income of about $56,000. It’s also higher than the median income for Hillary Clinton and Bernie Sanders supporters, which is around $61,000 for both.
- T0pH4t 4y agoI'm not even sure why you would attempt a study like this. It purely observational driven. There is no way to gauge whether the opposite parties policies would have resulted in more/less deaths. For all we know the decision made at the time (even with deaths) was the best possible outcome.
- mistrial9 4y agoupvote and amplify this -- there are hundreds of massive factors that are not at all causative via political voting. I have heard obesity rates mentioned in other comments, and that is consistent with trends I have seen. edit: hah- I said "obesity" and "massive factors" .. B&B score
- wolverine876 4y agoWhat factors did the study control for?
- res0nat0r 4y agoThis study is essentially saying the same thing that Jonathan Metzls' book, Dying of Whiteness said in 2020, in that a major cause of this is red controlled states rejecting Medicaid expansion vs. blue states embracing it leads to obvious worse outcomes for those folks who lack healthcare coverage. https://www.amazon.com/Dying-Whiteness-Politics-Resentment-Heartland/dp/1541644972/ https://www.amazon.com/Dying-Whiteness-Politics-Resentment-H...
- nr2x 4y agoSeems like a problem that will solve itself eventually, admittedly with much collateral damage.
- fzeroracer 4y agoWell no, unfortunately. Gerrymandering remains a massive problem that tips the scales in favor of more rural areas even as their population dwindles, leaving more power in the hands of fewer individuals. And often the people that suffer the most are the ones with the least opportunity.
- gumby 4y agoAs a recent kerfuffle about one of Louisiana's senators (Cassidy) shows: if you slice the data by race you'll see that the death rates for whites is closer to the rates of the States with good outcomes; the outcomes for black residents is much worse. In his case he was willing to point this discrepancy out, though he immediately blamed the victims. So if it sounds like it will sort itself out, it may end up doing so on the backs of the least enfranchised.
- gcheong 4y agoDepends on the relative replacement rates. Could be a while.
- reducesuffering 4y agoLongevity doesn’t matter for that, reproductive rate does (in addition to conversions), and it’s the opposite.
- splitrocket 4y agoAnd also: Poor folks don't survive long enough to become seniors who vote. https://nymag.com/intelligencer/2018/05/poor-people-often-dont-survive-to-become-seniors-who-vote.html https://nymag.com/intelligencer/2018/05/poor-people-often-do...
- tomrod 4y agoYep. I have done quite a bit of work in the SDoH space. It's pretty widely discussed thst there is a negative correlation of SDoH measures like ADI and age. Tragic.
- yesfitz 4y agoWhat are SDoH and ADI?
- wffurr 4y agoSDoH: https://i.imgur.com/SJUL4P6.png https://i.imgur.com/SJUL4P6.png ADI was a little harder, landed on https://www.ahajournals.org/doi/10.1161/JAHA.120.020466 https://www.ahajournals.org/doi/10.1161/JAHA.120.020466 after a few searches.
- tomrod 4y agoIndeed! The current iteration: https://www.neighborhoodatlas.medicine.wisc.edu/ https://www.neighborhoodatlas.medicine.wisc.edu/
- classichasclass 4y agoSDoH: Social determinants of health Not sure if this is what OP meant, but I read ADI as acceptable daily intake. Area deprivation index might also fit.
- tomrod 4y agoApologies for the jargon ADI: Area Deprivation index https://www.neighborhoodatlas.medicine.wisc.edu/ https://www.neighborhoodatlas.medicine.wisc.edu/
- deleted 4y ago[deleted]
- ravitation 4y agoI would caution people from putting words in the authors' mouths. The correlation can be meaningful in and of itself.
- akomtu 4y agoTL;DR Owners of Aston Martins live 10 years longer. Implication: if you buy one, you too will live longer. This example of pseudo logic is very popular in politics because most voters struggle with logic, but love to look smart, so pseudo logic aopeals to them.
- Barrin92 4y agothat's not the TL;DR of the piece at all. One important point the article talks about is the expansion of Medicaid to at risk individuals predominantly in blue states, and it seems intuitive that this is politically causative rather than just class correlation.
- bobkazamakis 4y ago> pseudo logic facts don't care about your feelings; red states average higher obesity rates.
- akomtu 4y agoIs it redness of the state that makes people obese, or does obesity cause redness? Both are valid hypotheses we need to consider.
- jimt1234 4y agoObesity. I grew up in a "deep red" area of the Midwest. It wasn't always like this, but it seems obesity is the norm now. And obesity has many health consequences. It's probably more cultural than political, though.
- windowsrookie 4y agoI live in the Midwest. If you drive past the suburbs, the only restaurants available are fast food burger, fried chicken and pizza chains, with a subway thrown in (I don't consider subway healthy). Obviously it's not profitable to own a healthy restaurant out there, but why? Is it a lack of healthy eating education? Is it a "harder" life and junk food is a reward? Or is it cost? If it's cost, healthy home cooked food is as cheap or even cheaper than unhealthy fast food. But so many people I talk to think it's cheaper to get fast food. If you have a shred of common sense you can make really tasty and cheap healthy food at home.
- jjtheblunt 4y agoi'm from the chicago area (nice suburban part) and totally agree. I suspect it's also something like 5x cheaper to compose healthy meals 5x healthier at home, IF one has a home in which such can be done.
- vorpalhex 4y agoAmerican palettes are screwed up. Most people wouldn't eat a meal of a simple salad, some lean protein and a multigrain carb.
- mjevans 4y agoAmerican "salads" are BS. * BS Leaf (some worthless lettuce) * Mostly filler of BS Leaf * Poor in vegetables * Poor in seeds / nuts * Frequently small or cheap protein * A 'shelf stable' dressing for flavor Yes, I've _considered_ making a salad at home, but by the time I buy ingredients I either have to eat the same for half a week in a row to try to use them up before they go bad, or just outright overpay. No, I can't go out and just buy one. Most places (there might be 1 or 2 out of like 30-40 restaurants 'car drive') near me only make a 'BS salad'. What I could really use is a sort of 'ghost kitchen' that takes relatively simple recipes based on bulk ingredients that are in stock at fair prices and makes a meal. Or maybe even just reusable snapware packs individual ingredients at sane sizes.
- Consultant32452 4y agoHere's a crazy experiment to try. Try to find some decent statistics on how many lives are saved by modern healthcare in countries you think have good healthcare systems. Basically try to prove that modern healthcare, when viewed in total, is a net benefit. Keep in mind that medical error is one of the leading causes of death. And things like: you were sick and took an antibiotic. Maybe you recovered faster, but you probably would have survived even without the antibiotic. I believe it is a benefit as a matter of faith, but I couldn't prove it to a skeptical person.
- bsuvc 4y ago> Black Americans experienced largely similar improvement in AAMR in both Democratic and Republican counties. Doesn't this prove that it is something other than who your county voted for in the last presidential election causing an increase in AAMR? > Rural Republican counties experienced the highest AAMR and the least improvement What if living in a rural area is more of a factor than being a "Repulican county"? This study seems like it is bending over backward to try to tie the risk of death to who you voted for in the presidential election.
- lallysingh 4y agoWhat are you quoting? I can't find the phrase "AAMR" in the article at all. Nor "Black Americans."
- tinalumfoil 4y agohttps://www.bmj.com/content/377/bmj-2021-069308 https://www.bmj.com/content/377/bmj-2021-069308
- tclancy 4y agoIt looks like an intentional cherry pick of this to avoid the fact it doesn't say what they suggest: >What is perhaps most telling in our study is that while both Black and Hispanic Americans experienced largely similar gains in health regardless of what political environment they lived in, with Black residents of Democratic areas experiencing the greatest reduction in deaths rates of any major racial-ethnic group, the sharpest divide is seen among white Americans. In fact, the fourfold growth in the gap in death rates between white residents of Democratic and Republican areas seems to be driving most of the overall expanding chasm between Democratic and Republican areas.
- bsuvc 4y agoFrom the abstract of the actual study, not the article. https://www.bmj.com/content/377/bmj-2021-069308 https://www.bmj.com/content/377/bmj-2021-069308
- bombcar 4y ago
- bjourne 4y agoA key takeaway from the study is that Americans are getting healthier. Figure 5 shows a big drop in heart disease which must be due to more exercise and better eating habits. Also: "In this national analysis, we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a Republican candidate, and these patterns were *consistent across subgroups (sex, race and ethnicity, urban-rural location).*" I.e. many of the tried and true methods of "explaining away" a study's result does not apply.
- bergenty 4y ago
- ricw 4y agoNot a doctor, but I believe that has to do with vastly improved survival rates for heart attacks. Hospitals have just gotten much better about it, by knowing that they have to act fast and having procedures in place to ensure that happens. 20 years ago a heart attack had a very high chance of death, even if you’re close to a hospital. These days, you’re much less likely to die if you get to a hospital / medic in time.
- comrh 4y agoWe've also made great reductions in smoking > Current smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020 (CDC)
- bjourne 4y agoDidn't think about that. Regardless, the other decreases in AAMR are consistent with improved health. It cannot all be due to improved healthcare.
- dismantlethesun 4y agoWhy would that make Democratic voting counties see improvement but not Republican voting counties?
- scantis 4y agoWhy are the democratic counties nearly halfed over the study, while the republican counties increase slightly? While the number of people increase? Are democrat counties growing together? "The study period covered five presidential elections from 2000 (673 Democratic counties, 132 833 397 population; 2439 Republican counties, n=147 957 141) to 2019 (490 Democratic counties, n=176 971 611; 2622 Republican counties, n=145 413 920) (supplementary tables 1 and 2)."
- 1986 4y agoYou'll notice the totals are the same (673 + 2439 = 3112, 490 + 2622 = 3112), the changes are likely due to the counties' flipping in elections.
- scantis 4y agoOkay so the counties flip, the democrats loose counties overall and gain 40 million ish people?
- consp 4y agoSounds like city vs rural counties.
- scantis 4y agoThey address this and find the same gap in the normalized subset of rural vs metropolitan areas. The gap goes from 5 point to 66, which is slightly less. democrat 143 counties, n=91 809 974 to 156 counties, n=133 796 619 And republican 292 counties, n=61 407 202 to 280 counties, n=46 244 883 So overall health is improving, but it is improving more when increasing sample size. It is normalized, but still different things are compared. Thanks I didn't know all that about democrats and counties, seems more involved then I thought.
- crooked-v 4y ago"County" by itself means very little when it comes to population. There are more people living in Los Angeles County alone than there are in some entire states.
- jeffbee 4y ago
- JaceLightning 4y agoWhat is strange is the article stated this only held true for white people.
- floxy 4y agoAnyone have a good reference for how age-adjusted mortality rates are calculated? I guess the most striking thing is the ~50% difference in AAMR between Black and Hispanic populations (Figure 3 of the BMJ paper). Although I'm not really sure what the AAMR is. I wonder what the data looks like if it were presented as a life expectancy number (or maybe mean age of death and its standard deviation). Wouldn't that convey essentially the same thing?
- jschveibinz 4y agoThe conclusion reached by the authors in the original paper does not say “US death rates show how politics affect public health.” Here is the rather simple conclusion they reached: > Conclusion: The mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008. That’s it.
- Sloppy 4y agoMaybe true but is it causal? Said another way, maybe counties with poor medical facilities, poorer people, etc. are more attracted to voting Republican. The title might read "The downtrodden are more attracted to Republican ideas" Not saying this is true either it's just that the causal factors may not be part of the study. They tried to include race/color and gender but the effect is still visible across the board. They did not study obesity or income level, which I suspect would show even stronger correlation to an increase in AAMR than what the county voted in the last election.
- t0bia_s 4y agoPolitics also affects birth rate.