The following is based upon Warraich et al. 2022 and Lofgren 2025.
Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced larger decreases in death rates than residents of counties that voted for a Republican candidate. The results indicate that the gap in overall death rates between Democratic and Republican counties increased more than sixfold from 2001 to 2019, especially for white populations, and was driven mainly by deaths due to heart disease, cancer, chronic lung disease, unintentional injuries, and suicide.
The researchers suggest that this widening gap may reflect the influence of political environments on social, economic, and health policies.
Previous studies have indicated that US counties that elect Republican candidates tend to experience worse health outcomes. However, recent trends in mortality differences between residents of Republican and Democratic counties are unknown, as are the conditions that might be driving those changes.
To address this uncertainty, a team of researchers set out to assess recent trends in age-adjusted mortality rates (AAMRs) in the United States based on county-level presidential voting patterns.
Their findings are based on Centers for Disease Control and Prevention data linked to county-level data on US presidential elections. The county political environment was classified as Democratic or Republican for the four years following a November presidential election.
The researchers also repeated the analysis, focusing only on counties that voted exclusively Democratic or Republican over the past two decades, and performed a study using state gubernatorial election results rather than presidential elections.
The overall study period covered five presidential elections from 2000 to 2019 and included data for 99.8% of the US population.
Between 2001 and 2019, mortality rates decreased by 22% in Democratic counties (from 850 to 664 per 100,000), but by only half that (11%) in Republican counties (from 867 to 771 per 100,000).
Consequently, the gap in mortality rates between Republican and Democratic counties jumped by 541%, from 16.7 per 100,000 in 2001 to 107 deaths per 100,000 in 2019.
Over the study period, male and female residents of Democratic counties experienced both lower mortality rates and a relative decrease in mortality rates twice that of their counterparts in Republican counties.
Throughout the study period, Black Americans experienced broadly similar improvements in age-adjusted mortality rates in both Democratic and Republican counties. However, residents of Democratic counties appeared to do better.
However, the mortality gap between white residents in Democratic versus Republican counties increased fourfold, from 25 to 101 per 100,000. As such, white residents in Democratic counties experienced 15% lower mortality rates in 2019 than white residents in Republican counties, compared with just 3% in 2001.
Hispanic Americans had lower mortality rates than either white or Black Americans, but there was little gap between those residing in Democratic versus Republican counties.
Rural Republican counties experienced the highest mortality rates and the least improvement over the study period, suggesting that the political environment has an important role to play in the widening urban-rural mortality gap, say the researchers.
The rising mortality gap between Republican and Democratic counties over the study period was driven mainly by deaths due to heart disease, cancer, chronic lung disease, unintentional injuries (including drug overdoses), and suicide.
This is an observational study, so it can’t establish cause, and the authors highlight some limitations. For example, they dichotomized the political environment based on the party receiving the majority vote, rather than using a continuous measure such as vote share or margin. Furthermore, It is possible that poor health or social and economic factors that lead to poor health also motivate political preference.
However, trends were similar when comparing counties that did not switch political environment throughout the study period and when using state election results for governor, suggesting that the findings are robust.
As such, they conclude: “Overall, our finding that Democratic counties have experienced steeper declines in mortality than Republican counties over the past two decades builds upon previous evidence suggesting that more liberal policies, laws, and regulations may be associated with better health outcomes.”
And they call for further research “to better elucidate factors driving this widening difference in mortality rates between Republican and Democratic counties, to inform clinical, public health, and policy strategies to improve the health of all Americans.”
This study adds to mounting evidence of a link between political party affiliation and death rates and of worrisome trends associated with more conservative policies sweeping the nation, says Steven Woolf at Virginia Commonwealth University in a linked editorial.
He notes that Republican-led legislatures in dozens of state capitols are passing laws to undermine health and safety regulations, ban abortion, limit LGBT+ rights, and implement more conservative policies on voting, school curricula, and climate policy.
To understand the implications for population health, researchers must break with custom, he writes. “Although scientific literature has traditionally avoided discussing politics, the growing influence of partisan affiliation on policies affecting health makes this covariate an increasingly important subject of study.
“Well, we all are going to die,” Iowa Republican Sen. Joni Ernst responded to a constituent who said “people are going to die” because of the cruel provisions of U.S. President Donald Trump’s “Big, Beautiful Bill.” Ernst is correct, we are all going to die, but what she and the Republican Party appear to want is for specific groups to die and die earlier than they should.
That’s a shocking statement and a hard one to make. But before you dismiss it, look at the evidence that’s accumulated over the years.
Republicans’ lack of concern for the lives of others appeared during the pandemic in a push to reopen businesses before vaccines and drugs were available. This would significantly increase COVID-19 transmission. Republicans railed against and dismantled every public health mitigation strategy. They knew that the deadliest toll would be on the elderly, infirm, migrants, and the poor—the most vulnerable and the least welcomed by Republicans. Texas Lieutenant Gov. Dan Patrick supported reopening, arguing that grandparents should willingly risk death by COVID-19 to save the country’s economy for their children and grandchildren. Arizona’s former Republican Gov. Doug Ducey also prioritized the economy over human lives, taking numerous steps to undermine public health measures. In the end, the pandemic death rates were higher in Arizona than in any other state.
The Republican plan, to let Covid-19 rip to save the economy, held an unspoken benefit for them; Covid-19 deaths would remove unwelcome people—overwhelmingly elderly, Black or brown, poor or living with disabilities—from the rolls of the social programs that Republicans dislike. There was a blatant disregard for the lives of others.
Concurrently, Republicans spread misinformation about COVID-19 vaccines and masking, with President Trump being the single most significant driver of COVID-19 misinformation. This turbocharged the present-day anti-public health, anti-science, anti-vaccine sentiments that endanger the U.S., culminating in the appointment of Robert F. Kennedy, Jr., a nonscientist and anti-vaccine advocate, to head the Department of Health and Human Services (HHS).
Kennedy and Trump have methodically weakened the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the U.S. Agency for International Development (USAID), and the National Institutes of Health (NIH). Kennedy systematically removed vaccine experts, replacing them with anti-vaccine cronies. His mounting campaign to cease vaccination will allow the return of serious and deadly diseases. Once again, this will have the most significant adverse effects on groups Republicans oppose. Kennedy and Republicans have also cut funding for HIV vaccine research and suicide hotlines for LGBTQ+ youths and are doing all they can to ban gender-affirming care for young people. All of this endangers the lives of groups that Republicans scorn.
The infamous “Big Beautiful Bill” allows Republicans to further undermine the health of those they disfavor, with its draconian funding cuts to safety-net programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). These programs serve the most vulnerable U.S. residents—those with disabilities or who experience poverty and already struggle for adequate healthcare and nutrition. Ultimately, the bill would end access to healthcare and proper nutrition for 14 million of the most vulnerable people in the U.S., intentionally endangering their lives.
And let’s not forget Florida’s Alligator Alcatraz, the Republicans’ detention center for migrants. The center’s design and location are not conducive to sustaining life or health. The cruelty of the place delights Republicans.
It doesn’t stop with the unwelcome in America. The Trump administration’s closure of USAID removed U.S. humanitarian and development assistance from people in the worst situations worldwide. USAID provided food, clean water, lifesaving medicines, and assistance for farmers; kept women and girls safe; and promoted peace. Due to Trump’s cruel closure of USAID, as many as 95 million people will be denied basic healthcare and nutrition, potentially leading to more than 3 million preventable deaths per year. The halting of funding for USAID, as well as the President’s Emergency Fund for AIDS Relief (PEPFAR), could cause an additional 4-11 million new HIV infections and up to 2.9 million HIV-related deaths between 2025 and 2030. Further, Kennedy has pulled out of the vaccine alliance Gavi, an organization that has paid for the vaccination of more than 1 billion children worldwide.
These cruel decisions endanger the most vulnerable around the world. But Republicans will never care about these Black and brown people who come from “shithole” countries, according to Trump. In their eyes, they are among the unwanted.
Some may see the Republicans’ plans as 21st-century eugenics to improve the white race by diminishing everyone who is nonwhite, non-straight, disabled, non-Republican, and non- Christian. Many are reluctant to talk about this because it seems so unthinkable. Still, we must reckon with the strong possibility that this administration actively wants some of us to go away. Look at what is happening, and remember that if it looks like a duck, walks like a duck, and quacks like a duck, it’s probably a duck.
Widening Mortality Gaps Between Democratic and Republican Counties
Americans residing in counties that voted for Democratic candidates in presidential elections from 2000 to 2016 experienced larger decreases in death rates than those living in counties that supported Republican candidates. The results indicate that the disparity in overall death rates between counties voting Democratic and those voting Republican increased more than sixfold from 2001 to 2019, with the most significant differences observed among white populations. Deaths primarily drove this growing gap due to heart disease, cancer, chronic lung disease, unintentional injuries, and suicide.
Researchers propose that this expanding divide may be attributed to the influence of political environments on social, economic, and health policies. Previous studies have shown that U.S. counties electing Republican candidates often experience worse health outcomes. However, recent trends in mortality differences between residents of Republican and Democratic counties, as well as the underlying causes, remain poorly understood.
Research Approach and Findings
To address these uncertainties, a team of researchers analyzed trends in age-adjusted mortality rates (AAMRs) across the United States, using county-level presidential voting patterns. Their work drew on data from the Centers for Disease Control and Prevention, linked to county-level results from U.S. presidential elections. Each county’s political environment was classified as Democratic or Republican for the four years following a presidential election.
The researchers repeated their analysis for counties that consistently voted exclusively Democratic or Republican over the two-decade period and performed a separate analysis using state gubernatorial election results rather than presidential elections. The study covered five presidential elections from 2000 to 2019 and included data for 99.8% of the U.S. population.
From 2001 to 2019, mortality rates fell by 22% in Democratic counties (from 850 to 664 per 100,000), compared to an 11% decline in Republican counties (from 867 to 771 per 100,000). As a result, the mortality gap between Republican and Democratic counties widened by 541%, from 16.7 per 100,000 in 2001 to 107 per 100,000 in 2019.
Throughout the study, both male and female residents of Democratic counties experienced lower mortality rates and a relative decrease twice that of their Republican-county counterparts. Black Americans experienced similar improvements in age-adjusted mortality rates in both types of counties, although outcomes were slightly better for residents of Democratic counties. The mortality gap between white residents in Democratic and Republican counties increased fourfold, from 25 to 101 per 100,000. By 2019, white residents in Democratic counties had a 15% lower mortality rate than those in Republican counties, compared to a 3% difference in 2001. Hispanic Americans had lower mortality rates overall, with little difference between Democratic and Republican counties.
Rural Republican counties exhibited the highest mortality rates and the least improvement over time, highlighting the role of political environment in the widening urban-rural mortality gap.
Underlying Causes and Study Limitations
The increasing mortality gap between Republican and Democratic counties during the study period was largely attributable to deaths from heart disease, cancer, chronic lung disease, unintentional injuries—including drug overdoses—and suicide. The researchers note that this is an observational study and cannot establish causation. They also acknowledge some limitations, such as classifying the political environment in a binary way, rather than by vote share or margin. Poor health or associated social and economic factors may also influence political preferences.
Nonetheless, similar trends were observed when analyzing counties that did not switch political environment and when using state governor election results, suggesting the findings are robust.
In conclusion, the study finds that Democratic counties have experienced steeper declines in mortality than Republican counties over the past two decades, supporting previous evidence that more liberal policies, laws, and regulations may be linked to better health outcomes. The authors call for further research to better understand the factors driving this widening mortality gap, with the aim of informing clinical, public health, and policy strategies to improve health for all Americans.
Lofgren M. 2025. Republicans Want You to Die Don’t believe it? Just look at their record. Common Dreams. May 13. https://www.commondreams.org/opinion/republicans-want-you-to-die
Lofgren M. 2025. Republicans Want You to Die Don’t believe it? Just look at their record. Common Dreams. May 13. https://www.commondreams.org/opinion/republicans-want-you-to-die
Warraich et al. 2022. Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis. BMJ 2022;377:e069308