Junk Science Warning: Voting Republican Could Kill You

Voting Republican could be hazardous to your health, especially if you live in a county that Donald Trump won.  

That’s the latest contribution to junk social science, this one brought to us by the distinguished British Medical Journal.

The authors tell us that counties that voted for GOP presidential candidates between 2000 and 2016 had smaller reductions in age-adjusted mortality rates over the past two decades than counties that backed their Democratic rivals.

Before the Biden administration requires presidential ballots to bear a surgeon general’s warning (“Voting Republican kills!”), it’s worth giving the study a closer look.

Its first and most obvious flaw is that hundreds of counties switched party preferences over the course of those five presidential elections. Then-Vice President Al Gore may have carried a given county in 2000, followed by then-Sen. John Kerry in 2004, and then-Sen. Barack Obama in 2008, but if Trump prevailed in 2016, its age-adjusted mortality reduction for the 2001-2019 period would be assigned to the GOP column.

This is a significant defect. Democrats carried 673 counties in 2000, but just 490 in 2016. Trump carried 2,622 in 2016, according to the study. Thus, the study classifies 183 counties that voted for Gore in 2000 as Republican in 2019 in measuring mortality changes over the 2001-2019 period.

The list of counties that backed one party or the other fluctuated over the five election cycles. Democrats won 673 counties in 2000 and 874 in 2008 before plunging to 490 in 2016. The list of counties the study compares is thus wildly inconsistent, rendering its findings suspect.

The authors also looked at a subset of counties that voted consistently for Republicans or Democrats in all five presidential contests. The results of that analysis were underwhelming.

Age-adjusted mortality in large metro counties fell by an identical 1.4% of residents between 2001 and 2019, whether those counties voted Democratic or Republican in all five elections. Small to midsize metro areas that backed Democrats in those five races had declines of 0.9% over that period, compared with 0.8% in comparable areas that voted Republican.

That difference isn’t statistically significant. The differences in rural counties are larger, but the confidence intervals (similar to the margin of error or plus/minus in public opinion polls) intersect, suggesting that the differences may be due to chance.

The increased urbanization of the Democratic Party and the GOP’s growing appeal to rural America might well explain the differences in mortality rate changes.

Despite Democratic nominees carrying 183 fewer counties in 2016 than in 2000, Joe Biden won more large urban counties than Gore. He prevailed in 156 large urban counties with a combined total of nearly 134 million residents, compared with just 46 million in such counties that backed Trump, giving Biden almost a 3-1 advantage in that category.

More than three-fourths of residents in counties that backed Biden lived in large metro areas, compared with just 32% for Trump.

Residents in rural counties that Trump won outnumbered those in rural Biden counties by nearly 8 to 1. Just 5.4 million lived in rural counties that backed Biden, making up just 3% of the residents in counties he carried.

In short, the differences the authors cite may well be explained by something we already know; namely, that Trump’s strength is in rural counties, where health status is poorer and life expectancies are shorter, while Biden’s power base is in urban centers, where medical care is generally state of the art.

Looking at the counties that voted consistently for the same party over all five presidential election cycles yields other anomalies. For example, average age-adjusted mortality for blacks declined by an identical 1.4% in both Democratic and Republican counties. Mortality among Hispanics fell by 1.6% in GOP counties, compared with just 1.3% in Democratic counties, although the confidence intervals overlap.

The only statistically significant difference is in mortality rate reductions among whites, which dropped by 1% over the period in Democratic counties, compared with 0.6% in Republican counties.

Do the authors believe that voting patterns produce reverse health inequities?

Design flaws and anomalies aside, the study is—at best—silly. It deploys dodgy statistical legerdemain to make a political point.

Absurdities abound. Are people who vote for a Democrat more likely to die because a Republican carried his or her county? Is it safe to vote Republican so long as you live in a county that reliably backs Democrats?

To their credit, the authors acknowledge that they could not “explain the link between political environment and mortality, and the direction of this association.”

Or whether there is any such link at all.

The British Medical Journal has published many studies that have advanced human knowledge and contributed to better medical care.

This isn’t one of them.

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