Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Mailman School of Public Health, Columbia University, New York, NY, USA.
J Gen Intern Med. 2019 Mar;34(3):363-371. doi: 10.1007/s11606-018-4568-6. Epub 2018 Sep 5.
The outcome of the 2016 presidential election is commonly attributed to socioeconomic and ethnic/racial issues, but health issues, including "deaths of despair," may also have contributed.
To assess whether changes in age-adjusted death rates were independently associated with changes in presidential election voting in 2016 vs. 2008.
We used publicly available data in each of 3112 US counties to correlate changes in a county's presidential voting in 2016 compared with 2008 with recent changes in its age-adjusted death rate, after controlling for population and rural-urban status, median age, race/ethnicity, income, education, unemployment rate, and health insurance rate.
Cross-sectional analysis of county-specific data.
SETTING/PARTICIPANTS: All 3112 US counties.
The independent correlation of a county's change in age-adjusted death rate between 2000 and 2015 with its net percentage Republican gain or loss in the presidential election of 2016 vs. 2008.
In 2016, President Trump increased the Republican presidential vote percentage in 83.8% of counties compared with Senator McCain in 2008. Counties with an increased Republican vote percentage in 2016 vs. 2008 had a 15% higher 2015 age-adjusted death rate than counties with an increased Democratic vote percentage. Since 2000, overall death rates declined by less than half as much, and death rates from drugs, alcohol, and suicide increased 2.5 times as much in counties with Republican gains compared with counties with Democratic gains. In multivariable analyses, Republican net presidential gain in 2016 vs. 2008 was independently correlated with slower reductions in a county's age-adjusted death rate. Although correlation cannot infer causality, modest reductions in death rates might theoretically have shifted Pennsylvania, Michigan, and Wisconsin to Secretary Clinton.
Less of a reduction in age-adjusted death rates was an independent correlate of an increased Republican percentage vote in 2016 vs. 2008. Death rates may be markers of dissatisfactions and fears that influenced the 2016 Presidential election outcomes.
2016 年总统选举的结果通常归因于社会经济和族裔/种族问题，但健康问题，包括“绝望死亡”，也可能有影响。
评估在 2016 年与 2008 年相比，年龄调整死亡率的变化是否与总统选举投票的变化独立相关。
我们使用了 3112 个美国县的公开数据，在控制了人口和城乡状况、中位年龄、种族/族裔、收入、教育、失业率和医疗保险率后，将每个县的总统投票在 2016 年与 2008 年的变化与该县的年龄调整死亡率的近期变化相关联。
县特定数据的横截面分析。
地点/参与者：美国的所有 3112 个县。
该县 2000 年至 2015 年期间年龄调整死亡率变化与 2016 年与 2008 年相比，其总统选举中共和党的净收益或损失百分比之间的独立相关性。
在 2016 年，与 2008 年的参议员麦凯恩相比，特朗普总统增加了 83.8%的县的共和党总统投票百分比。在 2016 年比 2008 年共和党投票百分比增加的县，2015 年的年龄调整死亡率比民主党投票百分比增加的县高 15%。自 2000 年以来，总体死亡率下降不到一半，而在共和党收益的县，与民主党收益的县相比，药物、酒精和自杀导致的死亡率增加了 2.5 倍。在多变量分析中，2016 年与 2008 年相比，共和党的净总统收益与该县年龄调整死亡率的下降速度较慢独立相关。尽管相关性不能推断因果关系，但理论上死亡率的适度降低可能会使宾夕法尼亚州、密歇根州和威斯康星州转向克林顿国务卿。
年龄调整死亡率下降幅度较小是 2016 年与 2008 年相比共和党投票百分比增加的独立相关因素。死亡率可能是影响 2016 年总统选举结果的不满和恐惧的标志。
