Age-adjusted mortality from all causes was 19.2% higher in states that voted for Donald Trump in 2024 than in states that voted for Kamala Harris, according to an analysis of publicly available mortality data. The difference has widened since 2016, when the rate in the states that later backed Trump was 17% higher.
The analysis compared mortality rates from 2016 to 2024, measured as deaths per 100,000 people and adjusted for age. In 2024, the rate was 774 per 100,000 in Trump-voting states and 649 in Harris-voting states. The gap was wider in 2021, during the Covid-19 pandemic.
The authors say the political divide in mortality predates the 2024 election. In 2001, age-adjusted mortality was 2% higher in counties where a Republican presidential candidate received the most votes than in counties where a Democrat did. By 2019, the difference had grown to 16.1%, as mortality declined more slowly in Republican-plurality counties.
Covid-19 contributed to the differences but does not account for the full pattern, the authors write. Covid mortality peaked at 86 deaths per 100,000 in Harris-voting states in 2020, while it continued to rise in Trump-voting states, reaching 122 per 100,000 in 2021.
Mortality from heart disease fell 9.1% in Harris-voting states between 2016 and 2024, compared with 2.9% in Trump-voting states. Cancer mortality declined by 12.9% and 9.1%, respectively. The authors argue that these trends point to chronic disease as a continuing part of the divide beyond the pandemic.
Drug overdose mortality followed a different course. It was 18% higher in Trump-voting states in 2016, but by 2024 was estimated to be 2% higher in Harris-voting states. The rates in Trump-voting states fell below those in Harris-voting states from 2023, after reaching a peak in 2021; the peak in Harris-voting states came in 2022.
The authors identify health policy and access to care as possible contributors. Medicaid expansion under the Affordable Care Act has been associated with lower mortality, they write, noting that the 10 states that had not adopted expansion all voted for Trump in 2024. They also point to greater coverage losses in non-expansion states during Medicaid unwinding and to challenges accessing care in rural communities, including hospital closures.
They also cite differences in education, economic opportunity, access to healthy food and internet service, and trust in health and public health institutions as factors that may shape health risks. The authors call for investment in affordable health care, education, rural and behavioral health services, and efforts to rebuild public trust. They caution against treating red and blue states as fixed categories of health risk, arguing that policy should address preventable deaths across communities.
Sources: STAT News.