Dataset Information

Life expectancy and voting patterns in the 2020 U.S. presidential election.

ABSTRACT:

Introduction

In the 2016 U.S. Presidential election, voters in communities with recent stagnation or decline in life expectancy were more likely to vote for the Republican candidate than in prior Presidential elections. We aimed to assess the association between change in life expectancy and voting patterns in the 2020 Presidential election.

Methods

With data on county-level life expectancy from the Institute for Health Metrics and Evaluation and voting data from a GitHub repository of results scraped from news outlets, we used weighted multivariable linear regression to estimate the association between the change in life expectancy from 1980 to 2014 and the proportion of votes for the Republican candidate and change in the proportion of votes cast for the Republican candidate in the 2020 Presidential election.

Results

Among 3110 U.S counties and Washington, D.C., change in life expectancy at the county level was negatively associated with Republican share of the vote in the 2020 Presidential election (parameter estimate -7.2, 95% confidence interval, -7.8 to -6.6). With the inclusion of state, sociodemographic, and economic variables in the model, the association was attenuated (parameter estimate -0.8; 95% CI, -1.5 to -0.2). County-level change in life expectancy was positively associated with change in Republican vote share 0.29 percentage points (95% CI, 0.23 to 0.36). The association was attenuated when state, sociodemographic, and economic variables were added (parameter estimate 0.24; 95% CI, 0.15 to 0.33).

Conclusion

Counties with a less positive trajectory in life expectancy were more likely to vote for the Republican candidate in the 2020 U.S. Presidential election, but the Republican candidate's share improved in some counties that experienced marked gains in life expectancy. Associations were moderated by demographic, social and economic factors.

SUBMITTER: Curtis LH

PROVIDER: S-EPMC8209240 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceIn the U.S. presidential election of 2016, substantial shift in voting patterns occurred relative to previous elections. Although this shift has been associated with both education and race, the extent to which this shift was related to public health status is unclear.ObjectiveTo determine the extent to which county community health was associated with changes in voting between the presidential elections of 2016 and 2012.DesignEcological study with principal component analysis (PCA) using principal axis method to extract the components, then generalized linear regression.SettingGeneral community.ParticipantsAll counties in the United States.ExposuresPhysically unhealthy days, mentally unhealthy days, percent food insecure, teen birth rate, primary care physician visit rate, age-adjusted mortality rate, violent crime rate, average health care costs, percent diabetic, and percent overweight or obese.Main outcomeThe percentage of Donald Trump votes in 2016 minus percentage of Mitt Romney votes in 2012 ("net voting shift").ResultsComplete public health data was available for 3,009 counties which were included in the analysis. The mean net voting shift was 5.4% (+/- 5.8%). Of these 3,009 counties, 2,641 (87.8%) had positive net voting shift (shifted towards Trump) and 368 counties (12.2%) had negative net voting shift (shifted away from Trump). The first principal component ("unhealthy score") accounted for 68% of the total variance in the data. The unhealthy score included all health variables except primary care physician rate, violent crime rate, and health care costs. The mean unhealthy score for counties was 0.39 (SD 0.16). Higher normalized unhealthy score was associated with positive net voting shift (22.1% shift per unit unhealthy, p < 0.0001). This association was stronger in states that switched Electoral College votes from 2012 to 2016 than in other states (5.9% per unit unhealthy, p <0.0001).Conclusions and relevanceSubstantial association exists between a shift toward voting for Donald Trump in 2016 relative to Mitt Romney in 2012 and measures of poor public health. Although these results do not demonstrate causality, these results suggest a possible role for health status in political choices.