U.S. death rates show how politics are affecting public health
statnews.comA 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.
Not 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.
We'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)
Didn't think about that. Regardless, the other decreases in AAMR are consistent with improved health. It cannot all be due to improved healthcare.
Why would that make Democratic voting counties see improvement but not Republican voting counties?
There could be a bunch of reasons. Republicans tend to live in rural counties, republicans are less likely to trust doctors, republicans are further from hospitals, or democrats are more likely to afford healthcare and accept public assistance.
Or it could be completely irrelevant. Who knows? (Note: Looks like the article authors controlled for the distance from hospitals)
Not over a year but over decades I expect many indirect consequences of policies - like an underfunded energy grid fails and you cannot get your heart attack treatment timely... like a butterfly effect, not immediately visible but snowballing over years in the statistics.
I am skeptical, because almost all of the effect was due to white populations in republican counties (as they point out in the article). Other ethnicities apparently performed similarly across counties (again, as they point out). Seems a lot more likely that the decline of racism over the recent decades has just made poor white people look like poor other ethnicities (which we do see in the data). This also correlates with switching to vote Republican because you tend to vote populist when you are getting screwed and the Republicans have been the party of populism for at least the last decade. Anyways, the point is this study should be viewed with extreme skepticism because it is doubtful they captured all the external confounding factors.
> Figure 5 shows a big drop in heart disease which must be due to more exercise and better eating habits.
Doubtful. Widespread use of statins, I should think, are a better match for that data.
It seems like everybody I know above 55 are on statins.
> sex, race and ethnicity, urban-rural location
What about income/economic class?
"A key takeaway from the study is that Americans are getting healthier."
Or perhaps just have better treatments?
Obesity.
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.
I 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.
In broad swaths of the midwest, the outside isn't especially attractive, if it's not outright ugly. Minimal elevation change anywhere in sight, little visible rock outside road cuts, very few—and all unimpressive—waterfalls, slow, muddy, gross streams and rivers. And the landscape may well be like that for hundreds of miles in any direction.
Then, on top of it, the weather's miserable 9 months out of the year. Oppressively hot & humid, or bitter cold. You're inside, you're in a pool/manmade-lake, or you're eagerly counting the minutes until you can get back to one of those places. Because of the first paragraph, incentive to brave the elements and go outside anyway, is practically zero.
IOW our natural environments and climates also discourage outdoor activity, pretty damn effectively.
[EDIT] Oh, and regarding this:
> 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?
It's a combination of cost and population density, mainly. Food culture plays in, but it's a feedback-loop sort of situation, not the case that food culture's purely driving the problem. Restaurants that optimize to avoid ingredients that spoil fast can charge less. Healthy ingredients tend to spoil faster than unhealthy ones (not universally true, but broadly so, especially for fruits and veggies). Higher prices (relative to local competition) mean a smaller customer base, which increases the population density required to support a restaurant.
That sounds depressing! But it's not my experience at all in the Midwest. I love the seasons. Summer can get a little hot, but there is still a lot to do around here. Winter is very fun to from cross country skiing, to fat tire biking, bonfires, and snowmobiling. I go out regularly in anything as low as -30F to -40F as long as I am dressed properly. Then we get Fall/Spring which are very special.
Honestly I've been to SF a lot and I find California down right dreary and boring!
Many in our area are farmers and they are a lot tougher than your post suggests.
The truth is healthy food is insanely expensive. We spend over $1000+/mo for two people. I know families with kids that eat on less than half that by eating less healthy.
> Many in our area are farmers and they are a lot tougher than your post suggests.
Heh, I come very directly from extremely country stock, so I'd never disparage their hardiness.
... However, even the farmers are rocking fancy trucks and climate-controlled combines & tractors with GPS guidance, these days :-)
AFAIK you still have to step out of your air conditioning to shoo loose cattle back in their pens, or mend a fence, though.
Not every agricultural operation is diversified like that. I don't have a great source, but this one is kind of ok if you flip back and forth between the maps. They have a better map that only works on desktop, and they have the raw data too.
https://www.nass.usda.gov/Publications/AgCensus/2017/Online_...
My Finnish perspective on cold. Our seasons are not as extreme as in the Midwest, but our culture has adapted to cold winters by necessity.
The winter clothes you wear when traveling from one indoor place to another are not appropriate for extended outdoor use, and the other way around. Many people need years or even decades to accept that they have to dress differently for the outdoors. Until that, they often think that cold temperatures are automatically unpleasant.
Freezing temperatures are rarely a problem as such. Wind and humidity can make them a problem. Inland forests tend to be more pleasant than open coastal areas in the winter.
Darkness makes everything much worse. Snow makes everything much prettier.
Finnish residential areas almost always have forests with walking trails nearby. I haven't been to the Midwest, but my impression is that American urban planning doesn't like leaving large undeveloped areas everyone is free to roam near developed areas. That often leaves the residents with nowhere to go by foot.
> Finnish residential areas almost always have forests with walking trails nearby. I haven't been to the Midwest, but my impression is that American urban planning doesn't like leaving large undeveloped areas everyone is free to roam near developed areas. That often leaves the residents with nowhere to go by foot.
That's the case where I am. 15 minute bike ride to reach the nearest park of any kind. There are no publicly-accessible forests within reasonable walking or biking distance (20+ minutes by car, largely on highways) and the ones that exist are few, tiny, and crowded because there's very little else around to do outside, as far as being-in-nature sorts of activities.
Most of our forests were destroyed decades ago by agriculture, and when we build housing developments we take all the plants off the land first, destroying any surviving trees and even stripping much of the topsoil (yes, seriously).
The nearest large region of sort-of-OK outdoor space we have is about 5 hours away by car. It's comparable to the worst parts of the Appalachian Mountains. You're looking at 12+ hours of driving to reach anything better than that.
Winter's definitely nicer than Summer, here. Uglier, but nicer. You can always wear more clothes. There's no beating the humidity, except to go indoors or get in water. Plus the mosquitos and ticks aren't out in Winter.
It's a little better if you own some rural land. At least you can go plink cans with a rifle or mess around on four-wheelers. Our forests have a way of developing nasty, thick, poison-and-thorn-filled underbrush that make them pretty miserable to be in if they're truly undeveloped, but if you manage to get some land with some trees on it and don't mind using some light-weight farm equipment to create and maintain some walking paths, that can be an alright time in Spring and Fall.
Wow, what a shame! I guess when there is too much land, politics don’t appreciate it anymore? But I think it should be reverseable - in Central Europe, forests got pretty much eliminated in pre-industrial age to get firewood. But since then there was a pretty significant reforestation. Well managed forests can be fairly profitable - you can get high quality food for furniture and housing, have family activities there etc. Around here, people of all political colors are big on hiking, doing some outdoor grilling or going to forest playgrounds. Plus, nowadays there is also a significant financial incentive in the form of CO2 certificates. Couldn’t that tip the scale towards reforestation?
Perhaps the restaurant selection reflects that most people in the region don't eat out? I too live in the general area of the "Midwest" (not really but close enough), and everybody I know cooks at home far more than they eat out, and more/better restaurants wouldn't change that behavior much since we are all poor. The problem then becomes what is cooked at home, and how much is eaten, and those aren't great. It's not for lack of available ingredients (although prices of "better" ingredients tend to play some role, like I'm not going to buy an "organic" bag of dirty carrots for 3x more than the regular dirty carrots from the same brand in the same package). In my unstudied and ignorant opinion, it comes down to a cultural thing, specifically a line of recipes and behaviors stemming from the Depression era. "Eat everything on your plate" is a common refrain, even when the plate is too big and too full. The same sort of calorie dense foods are made, but as scarcity decreased, gluttony increased, and that part simply hasn't gone back down yet.
"healthy home cooked food is as cheap or even cheaper than unhealthy fast food"
Is it? You can get a double cheeseburger, small fries and a large soda (the worst part arguably of the whole meal health wise) for 4 dollars at McDonalds. You can skip the fries, and get 2 double cheeseburgers for the same price. The McDonalds app will often give you a large fry for free for the 4 dollar purchase.
Whats the comparable food you can be making for 4 dollars at the grocery store?
Cooking only helps when you can get economy of scale going. And only when you can use up all the ingredients you can bought effectively. Also you need the energy to make the food, if you are getting up at 7am to get your kids to school, then pick them up at 6 (when after school ends) and get home at 630, and then need to cook for 30 minutes, then another 15 to get dishes and everything put away. Your looking at not even being "done" with "work" until 715pm when you started the day at 7am. Acting like the time to cook and clean is free is not productive.
I'm not going to list a whole bunch of recipes, there are many websites that have cheap healthy meal plans.
But for example...
1lb ground 90/10 turkey $3.69 1 bag of frozen mixed veggies $1.99 1/2 of a 1lb bag of rice. $.60 2 tablespoons of oil. ~$.05 1 tablespoon of soy sauce ~$.10
Total: $6.43
Throw rice plus water in a pan for 30 minutes. Add turkey, veggies, rice, ~2TBS. of butter/oil, 1TBS. of soy sauce. Done. Healthy fried rice. High in protein, healthy carbs/fiber from the rice and veggies, and low in sugar.
Should feed at least 3 people, all cooked in one pan and only requires 5 minutes of prep work. For $6.43. That's less than your one $4 meal at Mcdonalds costs, and it's significantly healthier (it has actual vegetables!). If you're just one person, It can be saved for later and re-heated in the microwave in 1 minute.
American palettes are screwed up. Most people wouldn't eat a meal of a simple salad, some lean protein and a multigrain carb.
American "salads" are BS.
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.* 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 flavorNo, 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.
Casual dining chains have hilariously high calorie "salads"
Clocking in at 1,570 calories: Applebee's Oriental Chicken Salad With Crispy Chicken
Not really true in my experience, unless you're talking about side salads at typical restaurants. At a "main salad" kind of place, you can do a lot better in terms of greens, nuts, dressing options. Look at the menus for chains like Sweetgreen or Simply Green
I haven't seen any of those near me, are they regional?
Not regional, but limited to a relatively small number of major metro areas[1]
[1] https://www.scrapehero.com/location-reports/Sweetgreen-USA/
At home, I keep a spinach/kale mix, dried fruit and several different nuts.
Vegetables and cheeses tend to rotate every week.
I often times do my protein on the side but that's preference.
I currently have a love affair with Kewpie's onion and garlic dressing but normally go for some olive oil and vinegar, a pinch of salt and black pepper.
i'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.
Guess what - thirty years ago the restaurants were all fries and burgers and we weren't overweight. We just eat out more, the portions are larger, and we love huge sugary drinks.
It's faster to get fast food than to cook at home. In the usual nuclear family, that's probably what they default to when both parents are working full-time.
[Yes, it's possible to make food in bulk on the weekends. There is no need to spam that helpful suggestion in the replies.]
There was an article on HN recently talking about how Americans spend less per capita on groceries than almost anywhere else. However, this is not the good news it seems to be on the surface. The race to the bottom in groceries and produce (ahem, Walmart) has lowered the nutrient density of produce while at the same time pushing cheap processed foods that provide cheap sugar, fat, and salt. I’d be interested in seeing how many Trump-voting counties also predominantly shop at Wal-Mart and the effect this has on health outcomes.
Doesn'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.
It’s access to care after 2008, democratic areas expanded it, republicans didn’t.
Sorry 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.
Here's the paper:
I 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.
Not really:
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.
Off topic, but good grief:
>> But it’s well above the national median household income of about $56,000
That's household.
And the Fed wants LOWER wages. What is wrong with people!? Pay more!
I'm curious how old you are and where you grew up.
In the 90s I would have considered $56,000 per year as rich. In the 2000s it would have been upper-middle class, or "senior white collar professional". In the 2010s probably down to "office job" or "good blue-collar job".
There's something funny about seeing people point to a salary that I grew up thinking was a best-case scenario dream as being insufficient. Maybe if our policies focused more on quality of life rather than nominal wages, we could help people instead of just having decades of inflation.
> In the 90s I would have considered $56,000 per year as rich.
If you look at historical income, $56k in 1995 is roughly where $100k is now, in terms of where it put you in the income distribution.
> In the 2000s it would have been upper-middle class, or "senior white collar professional"
In 2005, it's like a little under $85k today, again, by where it puts you on the income distribution, not buying power.
I think that the farther back you go, the more you are overstating what $56k was.
I'm in my 50s.
Stop blaming the working class when the rich keep taking a larger portion of the pie. Just stop.
I'm not sure why you're attacking me with this random, unrelated statement. I didn't "blame the working class" in any way, and re-reading my comment I can't come up with any interpretation of my statement that could be read as such.
Are you trying to suggest that the working class is the root cause of inflation, and that by me pointing out inflation it was an attack on that group? I genuinely can't figure out why you're angry here. Is this trolling? I'm confused.
I guess I misunderstood your comment. I apologize for that.
Shouldn't the median republican voter have an higher income (and way higher capital) than the median democrat voter?
I agree that if you go only at the top decile, the median democrat voter could make a bit more than the median republican voter (idk really), but if you take the whole population? I remember 2016 Sanders campaign funding.
Also, i went to West Virginia, an know the people there, happen to meet the local democrat (pro blue water, proponent of the redneck movement, basically a communist compared to the average american) and saw his electorate. I mean, they do live the good life, they eat venison and a lot of homegrown vegetables, they ride horses and sell lilies (no joke), brew their (mostly) bad beer and throw day-long parties on sunday where you jam from one PM to eleven (i improved more in two weeks there than in the last five year). But their income? i'd be surprised if they aren't in the last decile (or almost there).
> Shouldn't the median republican voter have an higher income (and way higher capital) than the median democrat voter?
It's not really this simple anymore.
Americans are sorting into the party of college grads (Democrats) and the party of non-college-grads (Republicans). This doesn't translate as neatly to income as you might think, but it's definitely a factor.
> they eat venison and a lot of homegrown vegetables, they ride horses and sell lilies (no joke), brew their (mostly) bad beer and throw day-long parties on sunday
This is not typical of any large group of voters, including in West Virginia. As someone who grew up there, I can tell you that most people buy food from Walmart. They don't grow it. There is certainly eating of venison, but frozen pizza is certainly more popular. Horses (and the riding of them) is uncommon.
Despite being oft-repeated, that educational claim isn't really true.
In 2016, Trump beat Hillary in white college-educated women, despite all the claims about gender and education popular in certain sections of media.
I think one big problem with discussion about American politics today is that we all pretend like "Republican" and "Democrat" are in any way logically consistent groups representing two opinions. The truth is, they're both completely absurd coalitions of diverse groups, bound up out of necessity by America having a two-party system.
Instead of trying to split people into two groups along whatever line - education, income, urbanization, race, religion, we should just accept that the parties are a hodgepodge of many different groups. For instance, the Democrats have as a coalition both Black voters and LGBT voters, despite the fact that Black Americans have been far less progressive on LGBT issues than White Americans. Republicans have as a coalition both "small government" fiscal conservatives and Christian social conservatives, despite these groups often having polar opposite policy goals.
> Despite being oft-repeated, that educational claim isn't really true.
I agree with this, it’s been my experience that most of the most intelligent and highly educated people I know are solidly GOP…except those who work in higher education. Although…some of them in higher education I know vote GOP, but claim they don’t, or don’t disclose it publicly.
Maybe 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.
The 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.
Isn't this basic demagoguery 101 -- attach huge social outcomes to the victory or loss of one political party?
Demagoguery 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.
good on you to look more carefully.. I would say that the emotion here is the health outcome.. by saying "super bad health outcome" == "that group over there" it appeals to emotions, because just about any whole person would care about health outcomes for others, and any literate person would very likely care about health outcome for themselves.
with the emotion being the health outcome response, I would tend towards Yes, demagogue.
In the case of the clickbait-ish title I would agree, but if the actual claim is an accurate representation of the data[0] how is one supposed to phrase that idea in a way that _wouldn't_ be considered demagoguery under this broad of a definition?
[0] I don't currently have time to verify this myself.
not a specialist but I have worked alongside specialists in public policy and public health, at scale. I think the first step is that you need to classify the parts of the population a few ways.. income, language group, age, relationships in close contact / living quarters; next layer is something about education, vocation, and remove or focus on real health outliers.. special needs, dangerous jobs, any circumstantial effects in their area that affect many people.
Any real studies in health sciences rely on statistics, so the treatment of the stats has to be defensible. That specifically is where they lose me, but that is how it is done.
I do not subscribe to the partisan politics world-view, in many, many ways.. so I was motivated to disparage the idea that this study is adequate to learn by the reader. I also am not going to take the time to really read this one. hth
The 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.
> In reality it's more likely that the average Republican voter skews both lower income and rural which is the true causation of deaths.
The author's based their analysis on data; is there data for your claim? There is plenty of poverty in cities.
EDIT: Quoting another commenter who quoted the OP: "[r]egardless of whether we looked at urban or rural areas, people living in areas with Republican political preferences were more likely to die prematurely than those in areas with Democratic political preferences"
Unless 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.
I 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-...
[2] https://www.washingtonpost.com/politics/2022/01/11/democrat-...
One party is hurting their own constituents by limiting access to healthcare at the state level. Verifying this actually has negative outcomes isn’t inherently political. Imagine if the research showed zero correlation, that would have been far more interesting.
Understanding the outcomes of political choices isn’t inherently political. It’s completely reasonable for someone to say yes this saves lives but it’s still not worth the money.
Really?
Only thing I can think of that is (sort of) a political decision to “limit health care” is refusing to expand Medicaid.
I know that didn’t happen across the board for Republican counties/states, though, so what in the world are you claiming?
That wasn’t the specific example I was thinking of, but it is illustrative of such policy decisions.
Credit where credit is due, Iowa and Hawaii actually rank very highly in terms of healthcare affordability and outcomes.
A different track, but the political decision on many on the right(media and personalities) to minimize the dangers of the virus, and demonize the vaccines caused bad outcomes.
https://abcnews.go.com/Health/red-blue-america-glaring-divid...
https://www.nytimes.com/2021/11/08/briefing/covid-death-toll...
https://www.pewresearch.org/politics/2022/03/03/the-changing...
It’s not about the victory or loss of either party. It’s saying there are two Americas developing simultaneously and people in each have different health outcomes.
Are the parties causative? Or are they just the labels that we have to describe the two groups currently? We don’t know.
> Are the parties causative?
Or is it the other way around? Commenters occasionally often point out the "red states" are the biggest recipients of welfare in spite of being the ones that vote most against it. To me, it seems that the most likely explanation for this is that the voters there see the negative effects of welfare and the ones who are voting for it are insulated most from the unintended consequences. It could just as easily be that the voters who see the most death are voting for the party they most feel will enact policies that will lead to less of it.
Before looking for cause, you always look for plausible co-variates. Here, there are a ton: red counties tend to be rural. Rural places have huge problems with health care access, obesity, addiction, poverty, and many other issues that predict poor health outcome.
The study takes ruralness into account, shown in this graph: https://www.bmj.com/content/bmj/377/bmj-2021-069308/F4.mediu...
That doesn't "take it into account"...it just plots them, based on which presidential candidate the county voted for. And by looking at the plot, it's clear that age-adjusted mortality rates are almost perfectly aligned for rural democratic and republican areas until 2009, when they drop suddenly for the democratic areas. Then they both continue tracking in parallel. Why is that? Can't tell. Sure is suspicious. Could it be that a bunch of counties flipped in 2008?
I skimmed this paper to see if the authors did any of the facepalm-obvious things you'd do to control for covariates if you were serious about doing an observational analysis (e.g. multi-factor regression), but saw nothing. They're literally just looking at differences in slopes in the lines:
> Trends in mortality were examined to identify changes in slope using Joinpoint Regression Program version 4.8.0.1, which models consecutive linear segments on a log scale, connected by joinpoints, and can measure when slopes of annual percentage change (APC) undergo a statistically significant change
This is a...well, let's just call it non-conventional...analysis method.
> Rural places have huge problems with health care access, obesity, addiction, poverty, and many other issues that predict poor health outcome.
So, yes, probably, but. I went in a rural area in West Virginia for some personal reasons. And i mean rural. One hours and a half from Charleston, and half an hour of the nearest town (population: 728). I think i met all the democrat voters there(four dozen or so :P). Mountain guides, kayak/raft guides, musicians(a lot), old hippies living off the land, a lily farmer, a lot of organic farmers too (And the first goat farmer who convinced me than US cheese is at least as good as french/italian goat cheese). Some of them without running water, almost half of them off grid. I think the "fatest" one was barely over my weight, so between 27 and 29 BMI. I also went to the organic farmer market in Hungtington (Clearly not republican leaning, as the sticker against mountain top mining, pro-unions and "Freedom Industries = Lexycon, protect our water" could show) and to a city music festival (were i met all those communist hippies again). Frankly, the overall health and shape of those people, i thought i was back in europe.
Poverty and health care access, yes. Addiction: not that much. Some are alcoholics, i think i met one meth user, but no one tried to sell to us, and their social life is way too full to have time for this shit. Obesity: clearly not. Less than in Paris.
Also, these people were clearly aware of the Elk river incident (it was four years after, still had banners and stickers warning about water quality) and did flush/replace their pipes, and could very well be the only ones who did.
That would only explain a point in time state of affairs but not why they observed the effect widen along party lines. Their theory was that blue areas expanded medicare and red areas didn't but there could be others.
Medicaid was expanded to cover those with low incomes in some states, not Medicare.
>Commenters occasionally often point out the "red states" are the biggest recipients of welfare in spite of being the ones that vote most against it.
Usually framed as "blue states are paying for the red states' welfare". But this isn't true.
First, the state of California does not pay a cent to another state or to the federal government. It is residents of California that pay federal taxes, which in turn provide funding and services to states and individuals.
Second, the Rockefeller Institute (<https://rockinst.org/issue-areas/fiscal-analysis/balance-of-...>) shows that, as of 2018 (the last time I checked this data; I see that 2019 is now available), the 10 states at the bottom of the per capita list—that is, the states that benefit from the most federal spending per person compared to how much each person pays in federal taxes—are
2016/2020 Hillary/Biden-voting states: VA, NM, MD, HI, 1/2 of ME
2016/2020 Trump-voting states: KY, AK, AL, WV, MS, 1/2 of ME
It's not so much "blue states" as per the above-mentioned claim, but taxpayers of four very wealthy Northeast states (the Tri-State area plus Massachusetts) that account for the vast bulk of citizens paying more than they receive from the federal government. After them come CO, NE, UT, and MN, of which half voted for Hillary/Biden and half for Trump. All other states, including CA, are net beneficiaries of the taxpayers in the top eight (and, again, really, it's the top four).
The end of the piece makes it pretty explicit what the point is actually: authors believe democratic policies are better and should be pushed to republican regions. They then go on to talk out of both sides of their mouth on this front, that "health care shouldn't be enmeshed with politics" but hoping that politicians will "listen" to them.
What people mean when they say that is that someone's opinion on evidence-based policies shouldn't be intertwined with their allegiance to a particular party. The entire point of politics is determining policy, and policy has an effect on the outcomes the doctors that wrote the article want to improve.
In any case authors are clearly making a political argument and implying if not explicitly making a causation argument here, not merely describing the state of the world.
The state of the world is the result of politics. You can't talk about one without talking about the other. Like the Texas energy grid being a disaster is the result of conservative deregulation and privatization. Merely describing the state means you're simply describing the effect and not the cause.
That's because of the two political parties, one is by far more prone to ratfucking. The authors are saying "get the ratfucking out of health care".
> Isn't this basic demagoguery 101 -- attach huge social outcomes to the victory or loss of one political party?
Isn't the entire point of politics and political parties to change social outcomes? "Your policy X will negatively impact social outcomes because reason Y while my policy Z will positively impact them" is a huge chunk of politics.
Besides, I don't see how actually trying to measure outcomes of specific policies is "demagoguery"? The author(s) of this paper may be wrong (I didn't look too deeply at the study), but that's not the same as "demagoguery".
I've become disturbed by this tendency the last couple of years to justify political decisions by appeal to public health. My own political leanings are complex, so I say this not from a partisan perspective.
It's very easy to specify hypothetical laws, that if enacted and enforced, would have dramatic public health benefits. A tyrrany of health, if you will. But that doesn't mean it would be ethically acceptable. Conversely, a great many military and other actions, ethically justified, are not healthy at all for its participants.
The problem with these political appeals based on public health is that physical health per se, or even health in general, is just one of many values to be weighted in decision making. I think there's been a general creep in what "health" encompasses, while being selective in other ways. I do think this is part of the reason for pushback from certain quarters, a reaction against trying to dress up politics in the disguise of science without being honest about it.
Science is always political to some extent, I think. So trying to argue that some phenomenon is a "scientific" issue, and therefore best addressed by qualified scientists seems disingenuous to me. It's not so much that expertise isn't real, it's that it has to have limits or it's meaningless.
I would advise reading the original paper as posted by several users: https://www.bmj.com/content/377/bmj-2021-069308
As I see it:
A) The paper is primarily a study of numerical trends.
B) Some potential policy causes for this difference are listed in the discussion section. While this is not the primary focus of this paper, the discussion links to several other prior studies regarding particular policies and their impacts.
C) However, more specific details (other than the above postulates) is not part of the paper's focus. This is acknowledged as a limitation in the study, and it is also acknowledged that other factors aside from policy (such as poor health or social and economic factors that may also motivate political preference) explain some of the hap. So it is important not to read too much detail into the cause of this gap at this time.
The numbers are the numbers. Care to take a stab at how they’re off track?
Yes, it is. It compares age-adjusted mortality rates without taking other factors into account. What this study shows is that upper middle-class urban and suburban voters - who are more likely to vote D - have a lower mortality rate than lower and lower middle-class rural voters - who are more likely to vote R. While the article states that [r]egardless of whether we looked at urban or rural areas, people living in areas with Republican political preferences were more likely to die prematurely than those in areas with Democratic political preferences it fails to notice that 'areas with democratic political preferences' in rural states tend to be more urban and as such have more upper middle-class D voters which resemble their ideological compatriots in coastal urban areas more than they have in common with the small town and rural R voters elsewhere in their rural states.
This may be just a classical correlation =/= causation error or it is campaign fodder for the upcoming elections.
And also: Poor folks don't survive long enough to become seniors who vote. https://nymag.com/intelligencer/2018/05/poor-people-often-do...
Yep. 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.
What are SDoH and ADI?
SDoH: https://i.imgur.com/SJUL4P6.png
ADI was a little harder, landed on https://www.ahajournals.org/doi/10.1161/JAHA.120.020466 after a few searches.
Indeed!
The current iteration: https://www.neighborhoodatlas.medicine.wisc.edu/
SDoH: 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.
I'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.
upvote 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
This 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-H...
What factors did the study control for?
I would caution people from putting words in the authors' mouths.
The correlation can be meaningful in and of itself.
"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
Of 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.
This 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-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.
A large percentage of the 70% GDP is the <1% megacorps/billionaires though, so it’s a complicated picture. Cities have huge inequality.
Surely the solution is for Democrats to force themselves on Republicans, who should accept this imposition of control for their own good.
The author specifically said that the solution is to find a less partisan approach. Who are you arguing with?
With 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).
> 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.
> What if living in a rural area is more of a factor than being a "Repulican county"?
The study controlled for that.
What are you quoting? I can't find the phrase "AAMR" in the article at all. Nor "Black Americans."
It 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.
From the abstract of the actual study, not the article.
It's likely another example of pet peeve #208 https://xkcd.com/1138/
Anyone 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?
Why 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)."
You'll notice the totals are the same (673 + 2439 = 3112, 490 + 2622 = 3112), the changes are likely due to the counties' flipping in elections.
Okay so the counties flip, the democrats loose counties overall and gain 40 million ish people?
Yes. The Democrats keep losing counties and gaining voters.
This is also happening at the state level, and is causing the Senate to become ridiculously radical. It only takes the support of 5.1% of US voters to filibuster a bill, and 12% to defeat a filibuster:
https://www.reddit.com/r/politics/comments/2jnmbe/i_did_the_...
The "supervoters" making up that 5.1% and 12% are mostly in Republican states, and this has led to the Republican party drifting farther and farther right of the mainstream over time. For example:
74% of Americans want action on climate change: https://www.pewresearch.org/fact-tank/2021/09/14/americans-a...
69% of Americans want to keep Roe v Wade: https://www.marketwatch.com/story/what-percentage-of-america...
Yet neither can get 50 votes in the Senate, let alone the 60 required to pass.
"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.
Sounds like city vs rural counties.
They 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.
Seems like a problem that will solve itself eventually, admittedly with much collateral damage.
As 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.
Longevity doesn’t matter for that, reproductive rate does (in addition to conversions), and it’s the opposite.
Well 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.
Depends on the relative replacement rates. Could be a while.
What is strange is the article stated this only held true for white people.
Politics also affects birth rate.
TL;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.
> pseudo logic facts don't care about your feelings; red states average higher obesity rates.
Is it redness of the state that makes people obese, or does obesity cause redness? Both are valid hypotheses we need to consider.
that'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.
Here'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.