Longevity
Age-adjusted death rates 19.2% higher in Trump-voting states than Harris-voting states, UCSF researchers find
By John Hyland, . Life and Health Today.
Death rates in the United States have been drifting apart along political lines for more than two decades, and the gap is now wider than at any point outside the peak of the COVID-19 pandemic. That is the central finding of an opinion piece published by STAT News, written by Brandon Yan, a physician and public health researcher at the University of California San Francisco Philip R. Lee Institute for Health Policy Studies; Maddie Feldmeier, a medical student at the UCSF School of Medicine; and Renee Y. Hsia, professor and vice chair of health services research at the UCSF Department of Emergency Medicine.
The authors compared publicly available mortality rates, adjusted for differences in age composition across states, between states that voted for Trump and states that voted for Harris in the 2024 presidential election, covering the period 2016 to 2024.
How large the gap is, and how it grew
In 2024, the age-adjusted mortality rate, meaning the death rate recalculated to account for the fact that some states have older populations than others, was 19.2% higher in Trump-voting states than in Harris-voting states: 774 deaths per 100,000 people compared with 649. In 2016, the same comparison showed a 17% difference, with 776 deaths per 100,000 in what would become Trump states versus 664 in what would become Harris states. The gap was even wider in 2021, when COVID-19 mortality was at its peak.
The divide is not new, but it was once much smaller. In 2001, age-adjusted mortality was just 2% higher in counties where a plurality voted Republican than in those where a plurality voted Democratic, according to the authors. By 2019, that figure had reached 16.1%, driven by mortality declining more slowly in Republican-leaning counties: down 11.1% compared with 21.9% in Democratic-leaning counties over that period.
Heart disease and cancer: where the gap is clearest
COVID-19 contributed to the widening, but the authors argue it is not the whole explanation. Heart disease mortality fell 9.1% in Harris-voting states between 2016 and 2024, but only 2.9% in Trump-voting states. Cancer mortality fell 12.9% in Harris-voting states and 9.1% in Trump-voting states over the same period. These are chronic diseases whose trajectories reflect years of health behavior, access to care, and screening, not a single epidemic.
The authors point to several structural factors. Medicaid expansion under the Affordable Care Act, which has been associated in prior research with lower mortality, has not been adopted by 10 states, all of which voted for Trump in 2024. Rural communities, which have historically leaned Republican, have also seen disproportionate hospital closures. The authors describe these as likely contributors, not proven causes: this is an observational comparison of state-level data, not a controlled study, and it cannot establish that any single policy difference is responsible for the mortality gap.
Drug overdoses: the pattern runs the other way
The drug overdose picture is more complicated. In 2016, overdose mortality was 18% higher in Trump-voting states, at 3.4 more deaths per 100,000. By 2024, the authors estimated that overdose mortality was 2% higher in Harris-voting states, at 0.4 more deaths per 100,000. Trump-voting states peaked earlier, at 35 deaths per 100,000 in 2021; Harris-voting states peaked later, at 32.5 per 100,000 in 2022. The authors describe an epidemic that began in rural and de-industrializing communities and has since spread to coastal and urban ones, where debates over harm reduction versus enforcement continue.
What the analysis does and does not show
This is an opinion piece by researchers, not a peer-reviewed study, and the authors are explicit that they are working from publicly available, aggregate state-level data. Grouping states by their 2024 presidential vote is a rough proxy: states contain enormous internal variation, and a state's political outcome does not describe the health of every person in it. The analysis identifies associations between political geography and mortality trends; it does not establish that voting patterns, or any specific policy, caused the differences.
The authors name education, economic opportunity, access to healthy food, media environment, and trust in public health institutions as additional factors shaping health outcomes across political geographies. Vaccination rate differences between Trump- and Harris-voting states, they write, illustrate how polarized trust in public health can translate into measurable mortality differences.
The piece was published during the 2026 midterm election season, when the authors note health care ranks third among voter concerns. The analysis can describe where mortality trends have diverged and at what pace; it cannot predict whether the gap will narrow or widen, nor which policy changes would move it most.
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