Association Between Partisan Affiliation of State Governments and State Mortality Rates Before and During the COVID-19 Pandemic.

IF 4.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Milbank Quarterly Pub Date : 2023-12-01 Epub Date: 2023-09-14 DOI:10.1111/1468-0009.12672
Steven H Woolf, Roy T Sabo, Derek A Chapman, Jong Hyung Lee
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Abstract

Policy Points The increasing political polarization of states reached new heights during the COVID-19 pandemic, when response plans differed sharply across party lines. This study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic-and in preceding years-but these associations often lost statistical significance after adjusting for the average income and health status of state populations and for the policy orientations of the states. Future research may help clarify whether the higher death rates in these states result from policy choices or have other explanations, such as the tendency of voters with lower incomes or poorer health to elect Republican candidates.

Context: Increasing polarization of states reached a high point during the COVID-19 pandemic, when the party affiliation of elected officials often predicted their policy response. The health consequences of these divisions are unclear. Prior studies compared mortality rates based on presidential voting patterns, but few considered the partisan orientation of state officials. This study examined whether the partisan orientation of governors or legislatures was associated with mortality outcomes during the COVID-19 pandemic.

Methods: Data on deaths and the partisan orientation of governors and legislators were obtained from the Centers for Disease Control and Prevention and the National Conference of State Legislatures, respectively. Linear regression was used to measure the association between Republican representation (percentage of seats held) in legislatures and (1) age-adjusted, all-cause mortality rates (AAMRs) in 2015-2021 and (2) excess death rates during three phases of the COVID-19 pandemic, controlling for median household income, the prevalence of four risk factors (obesity, chronic obstructive pulmonary disease, heart attack, stroke), and state policy orientation. Associations between excess death rates and the governor's party were also examined.

Findings: States with Republican governors or greater Republican representation in legislatures experienced higher AAMRs during 2015-2021, lower excess death rates during Phase 1 of the COVID-19 pandemic (weeks ending March 28, 2020, through June 13, 2020), and higher excess death rates in Phases 2 and 3 (weeks ending June 20, 2020, through April 30, 2022; p < 0.05). Most associations lost statistical significance after adjustment for control variables.

Conclusions: Mortality was higher in states with Republican governors and greater Republican legislative representation before and during much of the pandemic. Observed associations could be explained by the adverse effects of policy choices, reverse causality (e.g., popularity of Republican candidates in states with lower socioeconomic and health status), or unmeasured factors that predominate in states with Republican leaders.

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在 COVID-19 大流行之前和期间,州政府党派隶属关系与州死亡率之间的关系。
政策要点 在 COVID-19 大流行期间,各州日益加剧的政治两极分化达到了新的高度,各政党的应对计划大相径庭。本研究发现,在 COVID-19 大流行期间,共和党州长和共和党在议会中占多数的州的死亡率较高,在之前几年也是如此,但在对各州人口的平均收入和健康状况以及各州的政策取向进行调整后,这些关联往往失去了统计意义。未来的研究可能有助于澄清这些州较高的死亡率是政策选择所致,还是有其他原因,例如收入较低或健康状况较差的选民倾向于选举共和党候选人:背景:在 COVID-19 大流行期间,各州日益严重的两极分化达到了顶峰,当选官员的党派往往预示着他们的政策反应。这些分歧对健康的影响尚不清楚。之前的研究根据总统投票模式对死亡率进行了比较,但很少有研究考虑州官员的党派倾向。本研究探讨了州长或立法机构的党派倾向是否与 COVID-19 大流行期间的死亡率结果有关:死亡数据以及州长和议员的党派倾向分别来自美国疾病控制与预防中心和全国州议会会议。线性回归用于测量立法机构中共和党代表比例(所占席位百分比)与(1)2015-2021年年龄调整后全因死亡率(AAMRs)和(2)COVID-19大流行三个阶段的超额死亡率之间的关系,同时控制家庭收入中位数、四种风险因素(肥胖、慢性阻塞性肺病、心脏病、中风)的流行率和州政策取向。此外,还研究了超额死亡率与州长所属政党之间的关系:在2015-2021年期间,州长为共和党人或共和党人在立法机构中有更多代表的州的AAMR较高,COVID-19大流行第一阶段(截至2020年3月28日到2020年6月13日的几周)的超额死亡率较低,第二和第三阶段(截至2020年6月20日到2022年4月30日的几周;P < 0.05)的超额死亡率较高。在对控制变量进行调整后,大多数关联失去了统计学意义:在大流行之前和期间的大部分时间里,共和党州长和共和党立法代表较多的州死亡率较高。观察到的关联可能是由于政策选择的不利影响、反向因果关系(例如,共和党候选人在社会经济和健康状况较差的州受欢迎)或在有共和党领导人的州占主导地位的未测量因素造成的。
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来源期刊
Milbank Quarterly
Milbank Quarterly 医学-卫生保健
CiteScore
9.60
自引率
3.00%
发文量
37
审稿时长
>12 weeks
期刊介绍: The Milbank Quarterly is devoted to scholarly analysis of significant issues in health and health care policy. It presents original research, policy analysis, and commentary from academics, clinicians, and policymakers. The in-depth, multidisciplinary approach of the journal permits contributors to explore fully the social origins of health in our society and to examine in detail the implications of different health policies. Topics addressed in The Milbank Quarterly include the impact of social factors on health, prevention, allocation of health care resources, legal and ethical issues in health policy, health and health care administration, and the organization and financing of health care.
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