Objective To assess recent trends in age adjusted mortality rates (AAMRs) in the United States based on county level presidential voting patterns. Design Cross sectional study. Setting USA, 2001-19. Participants 99.8% of the US population. Main outcome measures AAMR per 100 000 population and average annual percentage change (APC). Methods The Centers for Disease Control and Prevention WONDER database was linked to county level data on US presidential elections. County political environment was classified as either Democratic or Republican for the four years that followed a November presidential election. Additional sensitivity analyses analyzed AAMR trends for counties that voted only for one party throughout the study, and county level gubernatorial election results and state level AAMR trends. Joinpoint analysis was used to assess for an inflection point in APC trends. Results The study period covered five presidential elections from 2000 to 2019. From 2001 to 2019, the AAMR per 100 000 population decreased by 22% in Democratic counties, from 850.3 to 664.0 (average APC −1.4%, 95% confidence interval −1.5% to −1.2%), but by only 11% in Republican counties, from 867.0 to 771.1 (average APC −0.7%, −0.9% to −0.5%). The gap in AAMR between Democratic and Republican counties therefore widened from 16.7 (95% confidence interval 16.6 to 16.8) to 107.1 (106.5 to 107.7). Statistically significant inflection points in APC occurred for Democratic counties between periods 2001-09 (APC −2.1%, −2.3% to −1.9%) and 2009-19 (APC −0.8%, −1.0% to −0.6%). For Republican counties between 2001 and 2008 the APC was −1.4% (−1.8% to −1.0%), slowing to near zero between 2008 and 2019 (APC −0.2%, −0.4% to 0.0%). Male and female residents of Democratic counties experienced both lower AAMR and twice the relative decrease in AAMR than did those in Republican counties. Black Americans experienced largely similar improvement in AAMR in both Democratic and Republican counties. However, the AAMR gap between white residents in Democratic versus Republican counties increased fourfold, from 24.7 (95% confidence interval 24.6 to 24.8) to 101.3 (101.0 to 101.6). Rural Republican counties experienced the highest AAMR and the least improvement. All trends were similar when comparing counties that did not switch political environment throughout the period and when gubernatorial election results were used. The greatest contributors to the widening AAMR gap between Republican and Democratic counties were heart disease (difference in AAMRs 27.6), cancer (17.3), and chronic lower respiratory tract diseases (8.3), followed by unintentional injuries (3.3) and suicide (3.0). 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. This analysis was performed using publicly available databases. Contact the corresponding author (hwarraich{at}partners.org) for queries about the analysis and statistical code.

中文翻译：

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2001-19 年美国的政治环境和死亡率：基于人口的横断面分析

目的 根据县级总统投票模式评估美国年龄调整死亡率 (AAMR) 的最新趋势。设计横断面研究。设置美国，2001-19。参与者占美国人口的 99.8%。主要结果衡量每 10 万人的 AAMR 和平均年百分比变化 (APC)。方法 疾病控制和预防中心 WONDER 数据库与美国总统选举的县级数据相关联。在 11 月总统选举之后的四年里，县政治环境被归类为民主党或共和党。额外的敏感性分析分析了在整个研究过程中仅投票给一个政党的县的 AAMR 趋势，以及县级州长选举结果和州级 AAMR 趋势。连接点分析用于评估 APC 趋势的拐点。结果 研究期间涵盖了 2000 年至 2019 年的五次总统选举。从 2001 年到 2019 年，民主党县每 10 万人的 AAMR 下降了 22%，从 850.3 下降到 664.0（平均 APC -1.4%，95% 置信区间 -1.5%至 -1.2%），但共和党县仅下降 11%，从 867.0 至 771.1（平均 APC -0.7%，-0.9% 至 -0.5%）。因此，民主党和共和党县之间的 AAMR 差距从 16.7（95% 置信区间 16.6 到 16.8）扩大到 107.1（106.5 到 107.7）。民主党县在 2001-09 年（APC -2.1%，-2.3% 至 -1.9%）和 2009-19 年（APC -0.8%，-1.0% 至 -0.6%）期间出现了 APC 的统计显着拐点。2001 年至 2008 年间共和党县的 APC 为 -1.4%（-1.8% 至 -1.0%），在 2008 年至 2019 年期间放缓至接近零（APC -0.2%，-0.4% 至 0.0%）。与共和党县相比，民主党县的男性和女性居民的 AAMR 均较低，AAMR 的相对下降幅度是共和党县的两倍。美国黑人在民主党和共和党县的 AAMR 方面经历了大致相似的改善。然而，民主党和共和党县白人居民的 AAMR 差距增加了四倍，从 24.7（95% 置信区间 24.6 到 24.8）增加到 101.3（101.0 到 101.6）。农村共和党县的 AAMR 最高，而改善最少。在比较整个期间没有改变政治环境的县以及使用州长选举结果时，所有趋势都是相似的。导致共和党和民主党县之间 AAMR 差距扩大的最大原因是心脏病（AAMR 差异为 27.6）、癌症（17.3）和慢性下呼吸道疾病（8.3），其次是意外伤害（3.3）和自杀（3.0） . 结论 共和党投票县与民主党投票县的死亡率差距随着时间的推移而扩大，尤其是白人人口，并且这种差距在 2008 年之后开始扩大。这项分析是使用公开数据库进行的。有关分析和统计代码的查询，请联系通讯作者 (hwarraich{at}partners.org)。结论 共和党投票县与民主党投票县的死亡率差距随着时间的推移而扩大，尤其是白人人口，并且这种差距在 2008 年之后开始扩大。这项分析是使用公开数据库进行的。有关分析和统计代码的查询，请联系通讯作者 (hwarraich{at}partners.org)。结论 共和党投票县与民主党投票县的死亡率差距随着时间的推移而扩大，尤其是白人人口，并且这种差距在 2008 年之后开始扩大。这项分析是使用公开数据库进行的。有关分析和统计代码的查询，请联系通讯作者 (hwarraich{at}partners.org)。