Who lives longer, Republicans or Democrats? The answer may surprise you. Many people hold the stereotype of Republicans being wealthy, being better educated, and having better access to healthcare. Democrats often hold the stereotype of being working class, poor, and wanting government healthcare handouts. Intuitively, this would translate to Republicans being healthier and living longer than Democrats.
- Health metrics correlate with the partisan index
- People living in Republican-leaning states have a significantly shorter life expectancy than people living in Democrat-leaning states
- Republican states have a higher COVID death rate, higher prevalence of obesity, and higher prevalence of smoking than Democrat-leaning states
- Residents of Democrat-leaning states have a higher annual household income than residents of Republican-leaning states
Historically, Republicans were found to be healthier than Democrats. In a 2009 article from the International Journal of Epidemiology, investigators analyzed data from the 1972 – 2006 General Social Surveys and found that survey respondents who identified as Republican had better self-reported health and were less likely than Democrats to be smokers. Similarly, a 2015 article from the journal Political Research Quarterly found that people who identified as having good health were more likely to vote Republican in the preceding presidential election.
A more recent study in the May 2022 edition of the British Medical Journal found that the association of political party with health may be reversing. This study compared the voting patterns of individual U.S. counties in the 5 presidential elections between 2000 to 2019 with the changes in the mortality rates in each of those counties during the same time period. The results indicated that counties voting Democratic had greater improvements in mortality rates than counties voting Republican. Moreover, the separation between improved mortality rates and political party voting only became apparent after 2008. This suggests that there has been a change over the past 15 years with Democrats now becoming the healthier of the two political parties.
It turns out that determining how political party affiliation affects life expectancy and other health metrics is quite difficult. Nowhere on a death certificate is there an entry for the doctor to record political party. Because our voting choices are confidential, there is no way to do a public record search for how dead Americans voted in the past Therefore, the only way to study political party affiliation and health outcomes is by correlation studies that look at voting patterns and health metrics of different geographic locations.
The Cook Partisan Voting Index
In 1997, a new method of determining political affiliation was developed called the Cook Partisan Voting Index. For the past 25 years, the index has been used to determine how strongly a congressional district or a state leans toward the Republican party or the Democratic Party. The index is based on voting patterns in the previous two presidential elections. The most recent data is based on voting in the 2016 and 2020 elections. The higher the number, the more strongly a state leans towards one political party.
In this table, Democratic-leaning states are in blue and are denoted with negative numbers; the more negative the number, the more the state leans Democratic. Republican-leaning states are in red and denoted with positive numbers; the higher the number, the more the state leans Republican. The most strongly Republican state is Wyoming and the most strongly Democratic states are Vermont and Hawaii. Two states (Nevada and New Hampshire) are equally split between Republican and Democratic parties and they are denoted in purple. The use of negative numbers for Democratic states and positive numbers for Republican states in this table is purely to facilitate statistical comparisons.
The Cook Partisan Index also reports the political leaning by individual congressional district. The most Democratic district is California’s 12th (Oakland area) and the most Republican district is Alabama’s 4th (rural northern Alabama).
Party affiliation and life expectancy
If we use the Cook Partisan Voting Index as a marker for party affiliation, then we can compare states with a high Republican index to states with a high Democratic index and see how those voting patterns correlate with health metrics. Life expectancy is one of the simplest of these metrics. Life expectancy can be measured in several ways. The most common measurements are (1) life expectancy from birth, (2) life expectancy from age 18, and (3) life expectancy from age 65. Each of these measurements has advantages and disadvantages.
Life expectancy from birth will be lower if there is a high infant and childhood mortality rate. Life expectancy from age 18 eliminates infant mortality but will be affected by gun-related deaths, drug overdoses, and motor vehicle deaths that are more common in young adults. Life expectancy from age 65 eliminates those young adulthood causes of death and is more affected by life-long unhealthy habits such as smoking, obesity, and alcohol abuse. For this analysis, let’s use life expectancy from birth since it incorporates all of the variables that can affect mortality from infancy through early adulthood and into older age.
In comparing the Cook Partisan Voting Index to life expectancy from birth, many people would suspect that Republicans would have a longer life expectancy than Democrats. However, just the opposite is true. People living in Democratic party states live longer than those in Republican party states. States that most strongly leaned Democrat had the longest life expectancy.
Overall, life expectancy in states found to be Democratic by the Cook Partisan Voting Index had a mean life expectancy of 79.6 years whereas the mean life expectancy in Republican states was 77.4 years (p < 0.001). This represents an average 2.2 year longer life expectancy in Democrat-leaning states.
Party affiliation and smoking
The finding of longer life expectancy in states that lean Democratic indicates that there has been a change in political party affiliation and health measures compared to older studies that showed Republicans were generally healthier than Democrats. One of the strongest predictors of life expectancy is smoking. In the past, Republicans were less likely to be smokers than Democrats. Could a change in the prevalence of smoking among people voting Republican versus Democrat be partially responsible for the change in life expectancy?
To answer this question, let’s examine the association between the Cook Partisan Voting Index and smoking rates by state. Each year, the Centers for Disease Control reports the percentage of adults in each state who smoke. Overall, the percentage of all Americans who smoke has been steadily falling since the mid-1960’s.
However, there are wide differences in smoking patterns between different states, ranging from a low of 7.9% of adults smoking in Utah to a high of 23.8% of adults smoking in West Virginia. Overall, states that lean Republican have a higher prevalence of smoking than states that lean Democratic (r = 0.64). The average adult smoking rate was 13.7% in Democrat states and 17.8% in Republican states (p < 0.001).
Party affiliation and obesity
A second health demographic that has changed over the past several decades is obesity. Overall, Americans have been becoming more obese each year. The CDC reports that the rate of obesity (BMI > 30) has increased from 30.5% in 2000 to 42.4% in 2018. Similarly, the rate of severe obesity (BMI > 40) has increased from 4.7% to 9.2%. These statistics are from the National Health and Nutrition Survey (NHANES) which is based face-to-face surveys performed in participating American’s homes by a physician and other health professionals.
As with smoking, there are substantial differences in the rate of obesity among different states. The Behavioral Risk Factor Surveillance System (BRFSS) reports obesity rates by state based on adult self-reported information from phone surveys. These self-reported obesity data differ from the NHANES data with a lower overall incidence of obesity than NHANES. This difference has been attributed to differences in how the data are obtained (in-person interview versus phone survey). The state with the highest rate of obesity is West Virginia and the state with the lowest rate of obesity is Colorado. Based on the BRFSS data, states that lean Democratic have an adult obesity prevalence of 29.1% and states that lean Republican have an adult obesity prevalence of 34.3% (p < 0.001)
Party affiliation and COVID mortality
One of the major causes of death in the United States in the past two years has been COVID-19. So far, 1,024,611 Americans are known to have died from COVID and many more have likely died from COVID or COVID complications that were not listed on death certificates. A study published last month in JAMA Internal Medicine found that in 2021, COVID was the 4th leading cause of death in Americans age 25-34 (after accidents, suicide, and assault), the number 1 cause of death in Americans age 45-54, and the 3rd leading cause of death in Americans over age 65 (after cancer and heart disease).
As noted in a previous post, there are significant differences in how Republicans and Democrats fared during the COVID-19 pandemic with residents in Democratic states more likely to be vaccinated against COVID, less likely to become infected with COVID, and less likely to die from COVID than residents in Republican states. By comparing the Cook Partisan Voting Index to the death rate of COVID for each state, we again find that the there is an association between party affiliation and death from COVID. Overall, 260 people per 100,000 population have died from COVID in Democrat-leaning states whereas 331 per 100,000 died from COVID in Republican-leaning states (p = 0.005).
Party affiliation and personal income
As noted earlier, historically Republicans had a higher self-reported annual income than Democrats. The stereotypical Republican was a capitalism-supporting business owner and the stereotypical Democrat was a blue collar worker who belonged to a union. Personal income has been shown to affect health outcomes with wealthier persons having better health and poorer persons having worse health. Could a change in income demographics between Republicans and Democrats be partially responsible of the shorter life expectancy of residents of Republican states?
By comparing household income to the Cook Partisan Voting Index, we find that residents of states leaning Democratic have a higher annual income than residents of states leaning Republican. The average income in Democratic-leaning sates was $71,264 and the average come in Republican-leaning states was $59,108 (p < 0.001).
Money is only worth what you can buy with it. The highest income states are also the states with the highest cost of living so the above analysis man not necessarily equate to the purchasing power of each household. Nevertheless, it appears that voters favoring Republicans in the last two presidential elections have a different relative annual income than voters favoring Republicans in previous presidential elections. Residents of states who have recently favored Republicans have a lower income than those favoring Democrats.
Today’s Republicans are not your parent’s Republicans
A generation ago, compared to Democrats, Republicans were wealthier, healthier, and less likely to smoke. Today’s Republicans have a lower income, are more obese, are more likely to smoke, and are more likely to die young than Democrats. This generational reversal in the relationship between party affiliation and health metrics has implications for future healthcare utilization.
For example, given a 2.2 year longer life expectancy, residents of Democrat-leaning states would be expected to utilize 18% more Medicare and Social Security benefits than residents of Republican-leaning states (assuming Medicare and Social Security benefits starting at age 65). The longer a person lives, the more elections that person can vote in. The results imply that people voting Democrat will vote in an average of 2 more annual elections over the course of their lifetimes than those who vote Republican.
Obesity is associated with other health conditions such as diabetes, hypertension, sleep apnea, and arthritis. This could indicate that people voting Republican are more likely to have these conditions in addition to being more likely to be smokers. The result could be a higher incidence of disability among people voting Republican than among people voting Democrat.
It seems paradoxical that people living in states that lean toward the Democratic party have higher incomes and thus are in higher income tax brackets and pay more in income tax than people living in states that lean toward the Republican party. Democrats are often characterized as favoring higher taxes whereas Republicans are generally characterized as favoring tax cuts.
We will not fully know all of the healthcare implications for the apparent change in voter demographics for several years. However, it is likely that the evolving differences in health metrics between states that vote Republican and states that vote Democrat will result in very different approaches to healthcare policy.
August 1, 2022