Political party affiliation, political ideology and mortality

Political voting in the United Kingdom 2019 general election and risk of living with obesity in a nationally representative sample

BACKGROUND

Limited evidence from the United States suggests that county/state rates of people with obesity are positively associated with voting for the Republican Party presidential candidate, although this question has not yet been studied at the individual level, and/or outside of the United States, where the health and political systems are very different in other countries.

OBJECTIVES

Using individual level data, assess differences in rates of people with obesity according to political voting in the United Kingdom 2019 general election, and examine whether people living in constituencies won by Members of Parliament (MPs) from the Conservative Party were more likely to be living with obesity than those living in constituencies won by MPs from other parties.

METHODS

Data was obtained by the Ipsos KnowledgePanel where panellists are recruited via a random probability unclustered address-based sampling method. 4000/14,016 panellists were randomly invited to provide data on socio-demographics, health outcomes, voting behaviour and height/weight.

RESULTS

2668/4000 (67%) of invitees provided data, 95/2668 (3.5%) were not eligible to vote, with the remaining 2573 (96.5%) included. Conservative Party voters were more likely to be living with obesity than those who voted Labour (OR:1.42 95% CI (1.01-1.99)) or Liberal Democrats (1.54 95% CI (1.00-2.37)). Conservative Party voters on average had significantly higher BMI scores than those voting Labour and Liberal Democrats; BMI mean difference 0.88 points (95% CI: 0.16-1.61) between Conservative and Labour voters, and 1.04 points (95% CI: 0.07-2.02) between Conservatives and Liberal Democrats voters. There was no evidence participants living in constituencies won by Conservative MPs were more likely to be living with obesity than constituencies won by other party MPs.

CONCLUSION

Governments and public health agencies may need to focus on the political affiliation of the public when developing strategies to reduce the number of people with obesity.

Hurt on Both Sides: Political Differences in Health and Well-Being during the COVID-19 Pandemic

Republicans and conservatives report better self-rated health and well-being compared to Democrats and liberals, yet they are more likely to reside in geographic areas with heavy COVID-19 morbidity and mortality. This harmed health on "both sides" of political divides, occurring in a time of rapid sociopolitical upheaval, warrants the revisiting of psychosocial mechanisms linked to political health differences. Drawing on national Gallup data (early 2021), we find that predicted differences in health or well-being vary substantially by ideology, party, voting behavior, and policy beliefs, with model fit depending on how politics are measured. Differences in self-rated health, psychological distress, happiness, trouble sleeping, and delayed health care tend to reveal worse outcomes for Democrats or liberals. Such differences often are reduced to insignificance by some combination of mastery, meritocratic beliefs, perceived social support, and COVID-19-related exposures and attitudes. Policy beliefs predict health differences most robustly across outcomes and mechanism adjustments.

Beliefs in COVID-19 Vaccine Misinformation Among Unvaccinated Black Americans: Prevalence, Socio-Psychological Predictors, and Consequences

Health-related misinformation is a major threat to public health and particularly worrisome for populations experiencing health disparities. This study sets out to examine the prevalence, socio-psychological predictors, and consequences of beliefs in COVID-19 vaccine misinformation among unvaccinated Black Americans. We conducted an online national survey with Black Americans who had not been vaccinated against COVID-19 (N = 800) between February and March 2021. Results showed that beliefs in COVID-19 vaccine misinformation were prevalent among unvaccinated Black Americans with 13-19% of participants agreeing or strongly agreeing with various false claims about COVID-19 vaccines and 35-55% unsure about the veracity of these claims. Conservative ideology, conspiracy thinking mind-set, religiosity, and racial consciousness in health care settings predicted greater beliefs in COVID-19 vaccine misinformation, which were associated with lower vaccine confidence and acceptance. Theoretical and practical implications of the findings are discussed.

Political Person-Culture Match and Longevity: The Partisanship-Mortality Link Depends on the Cultural Context

Recent studies demonstrate that Republicans live longer than Democrats. We examined whether these longevity benefits are universal or culturally varying. Following a person-culture match perspective, we hypothesized that Republicans' longevity benefits occur in Republican, but not in Democratic, states. To test this argument, we conducted two studies among U.S. adults. In preregistered Study 1, we used large survey data (extended U.S. General Social Survey; N = 42,855). In confirmatory Study 2, we analyzed obituaries/biographies of deceased U.S. political partisans (novel data web-scraped from an online cemetery; N = 9,177). Both studies supported the person-culture match perspective with substantial effect sizes. In Republican contexts, up to 50.1% of all Republicans but only 36.3% of all Democrats reached an age of 80 years. In Democratic contexts, there was no such longevity gap. Robustness tests showed that this effect generalizes to political ideology and holds across spatial levels but is limited to persons with strong political convictions.

Far-right political ideology and COVID-19 vaccine hesitancy: Multilevel analysis of 21 European countries

BACKGROUND

Far-right political parties across the EU have downplayed the risk of COVID-19 and have expressed skepticism toward the safety of the COVID-19 vaccine. This may affect the risk perception of people who support far-right parties and may be associated with an elevated risk of vaccine hesitancy. We aimed to explore if voting far-right is associated with COVID-19 vaccine hesitancy and if the association varies by individual and country-level factors.

METHODS

We used cross-sectional data from 28,057 individuals nested in 21 countries who participated in the tenth round of the European Social Survey (ESS). COVID-19 vaccine hesitancy was assessed by asking respondents whether they will get vaccinated against COVID-19. Voting behavior was measured by asking respondents which party they voted for in the last election. To test the association between far-right voting and COVID-19 hesitancy, we applied a series of multilevel regression models. We additionally ran models including interaction terms to test if the association differs by sociodemographic characteristics (e.g., institutional trust) or contextual factors (e.g., income inequality).

RESULTS

We found that far-right voters were 2.7 times more likely to be COVID-19 vaccine hesitant compared to center voters (PR: 2.69, 95% CI: 1.46-4.94). The association persisted even after controlling for institutional trust and social participation (adjusted PR: 2.15, 95% CI: 1.35-3.42). None of the tested interaction terms were significant suggesting that the association between political ideology and COVID-19 vaccine hesitancy does not differ by sociodemographic characteristics or contextual factors.

CONCLUSION

Voting for far-right parties is associated with COVID-19 vaccine hesitancy. The association is similar among European countries, regardless of how stringent the public health measures were and magnitude of income inequality in each country. Our findings call for a more in-depth investigation of why, how and under which conditions political ideology affects vaccination behavior.

Religious service attendance and mortality: A population-based prospective cohort study in southern Sweden

Aims

The aim is to investigate associations between attendance in religious service during the past year and all-cause, cardiovascular (CVD), cancer and other cause mortality.

Study design

Prospective cohort study.

Methods

A public health survey with three reminders was sent to a stratified random sample of the adult 18-80 population in southernmost Sweden in 2008. The response rate was 54.1%, and 24,855 participants were included in this study. The cross-sectional baseline survey was connected to mortality data with 8.3-year follow-up. Analyses were conducted in Cox regression models.

Results

13.9% had attended religious service at least once during the past year, and 86.1% had not attended. The group with religious attendance contained significantly higher proportions of women, high and medium position non-manual employees, participants born abroad, never alcohol consumers, respondents with high trust in others and respondents with high social participation. It also contained significantly lower proportions with low leisure-time physical activity (LTPA) and daily smokers. Religious service attendance during the past year was significantly associated with lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attendance until social participation items were introduced in the final model. HRRs of CVD mortality were significantly lower for religious attendance in the multiple models until BMI and health-related behaviors were introduced. No significant results were observed for cancer and other cause mortality.

Conclusions

The results suggest that religious service attendance in a highly secularized country such as Sweden is significantly associated with lower all-cause mortality, which may be explained by a social network pathway in this highly secularized population.

Differential COVID-19 preventive behaviors among Asian subgroups in the United States

BACKGROUND

Given the observed within-Asian disparity in COVID-19 incidence, we aimed to explore the differential preventive behaviors among Asian subgroups in the United States.

METHODS

Based on data from the Asian subsample (N = 982) of the 2020 Health, Ethnicity, and Pandemic survey, we estimated the weighted proportion of noncompliance with Centers for Disease Control and Prevention (CDC) guidelines on preventive behaviors and COVID-19 testing by Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian). We examined these subgroup differences after adjusting for demographic factors and state-level clustering.

RESULTS

Filipinos demonstrated the lowest rate of noncompliance for mask-wearing, social distancing, and handwashing. As compared with the Filipinos, our logistic models showed that the Chinese and the 'other Asians' subgroup had significantly higher risk of noncompliance with mask-wearing, while the Japanese, the Vietnamese, and other Asians were significantly more likely to report noncompliance with social distancing.

CONCLUSIONS

The significant variation of preventive behavior across Asian subgroups signals the necessity of data disaggregation when it comes to understanding the health behavior of Asian Americans, which is critical for future pandemic preparedness. The excess behavioral risk among certain Asian subgroups (especially those 'other Asians') warrants further investigation and interventions about the driving forces behind these disparities.

Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States

ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30 days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.

The interplay between partisanship, risk perception, and mental distress during the early stages of the COVID-19 pandemic in the United States

COVID-19 is a profoundly partisan issue in the U.S., with increasing polarization of the Republicans' and Democrats' responses to the COVID-19 pandemic and their precautionary actions to reduce virus transmission. Nevertheless, it remains unclear whether and how partisan gaps in many aspects of the pandemic are linked to mental health, which has increasingly been a major concern. This study examined the association between political partisanship and mental health by assessing the mediating and moderating relationships between risk perception, expected infection severity of COVID-19, and partisanship in terms of mental health during the early stages of the pandemic. The data were drawn from a cross-sectional web survey conducted between March 20 and 30, 2020, with a sample of U.S. adults (N = 4,327). Of those participants, 38.9% and 29.6% were Democrats and Republicans, respectively. The results indicate that Democrats were more likely to experience COVID-induced mental distress than Republicans, and higher risk perception and expected infection severity were associated with mental distress. Furthermore, risk perception and expected infection severity of COVID-19 mediated approximately 24%-34% of the associations between political partisanship and mental distress. Finally, the adverse mental health impact of risk perception and expected infection severity appeared to be much stronger for Republicans than Democrats. The findings suggest that political partisanship is a key factor to understanding mental health consequences of the COVID-19 outbreak in the U.S.

The Relationship Between Racial Prejudice and Cardiovascular Disease Mortality Risk at the State and County Level

BACKGROUND

Robust evidence shows that perceived discrimination among stigmatized groups is associated with negative health outcomes. However, little work has examined whether holding prejudiced attitudes toward others is associated with health risks for prejudiced individuals.

PURPOSE

The study is a test of the hypothesis that holding prejudicial attitudes has negative health implications for both the holders and targets of prejudicial attitudes.

METHODS

The project connected data (2003-2015) at the state and county levels on average explicit and implicit prejudice held by White, Black, and Native American respondents from Project Implicit with data on cardiovascular disease (CVD) mortality for White, Black, and Native American individuals from the CDC Wonder database. Separate analyses regressed implicit and explicit prejudice on CVD mortality risk for White, Black, and Native American individuals, respectively.

RESULTS

At the state level, among White individuals, explicit prejudice toward Blacks (β = .431, p =.037) and implicit prejudice toward Native Americans (β = .283, p = .045) were positively associated with greater CVD mortality for Whites. At the county level, White individuals' implicit prejudice toward Blacks (β =.081, p = .015) and Black individuals' implicit prejudice toward Whites (β = -.066, p = .018) were associated with greater CVD mortality for Whites. Also, at the county-level, among Black individuals, higher implicit (β = -.133, p < .001) and explicit (β = -.176, p < .001) prejudice toward Whites predicted CVD mortality for Blacks. Moreover, explicit prejudice held by White individuals was positively associated with Blacks' county-level CVD deaths (β = .074, p = .036).

CONCLUSIONS

This evidence suggests that across racial groups, holding racial prejudice is associated with CVD mortality risk for both the prejudiced and the stigmatized groups. Future research should verify the reliability of this potential public health effect with additional work explicating moderators and mediators to inform surveillance and interventions.

Political affiliation and risk taking behaviors among adults with elevated chance of severe complications from COVID-19

This study determines whether COVID-related risk-taking behavior was different among Republicans, Democrats, and Independents, in adults with elevated chance of severe complications from COVID-19. Using US national survey data collected September 30-October 27, 2020 (N = 6095), behaviors in the prior week examined were: 7 potentially risky activities, mask wearing anywhere, and mask wearing while undertaking each activity. Differences among political affiliations were estimated for adults with 0 and with ≥1 medical risk factors for severe complications, adjusting for sociodemographic factors. Among adults with medical risk factors, the adjusted number of potentially risky activities was higher among Republicans (3.83) but not Independents (3.17) relative to Democrats (2.98). The adjusted percentage of adults with medical risk factors who wore a mask anywhere in the past week was lower for Republicans (87%) and Independents (91%) than for Democrats (97%). While undertaking each specific activity, the adjusted percentage of at-risk adults never wearing a mask was higher for Republicans than Democrats: 24% vs 8% at bar/club; 6% vs 0% at grocery/pharmacy; 63% vs 30% visiting at friend's home; 68% vs 41% hosting visitors; 30% vs 5% at gathering of ≥10 people; 25% vs 11% while within 6 ft of someone they do not live with. Rates of mask wearing among political Independents were between rates among Democrats and Republicans. Efforts to reduce COVID-related risky behavior should recognize that although Republicans take more risks, rates of mask wearing at common activities are low across political affiliations, even for populations vulnerable to severe complications.

Viewing the US presidential electoral map through the lens of public health

Health, disease, and mortality vary greatly at the county level, and there are strong geographical trends of disease in the United States. Healthcare is and has been a top priority for voters in the U.S., and an important political issue. Consequently, it is important to determine what relationship voting patterns have with health, disease, and mortality, as doing so may help guide appropriate policy. We performed a comprehensive analysis of the relationship between voting patterns and over 150 different public health and wellbeing variables at the county level, comparing all states, including counties in 2016 battleground states, and counties in states that flipped from majority Democrat to majority Republican from 2012 to 2016. We also investigated county-level health trends over the last 30+ years and find statistically significant relationships between a number of health measures and the voting patterns of counties in presidential elections. Collectively, these data exhibit a strong pattern: counties that voted Republican in the 2016 election had overall worse health outcomes than those that voted Democrat. We hope that this strong relationship can guide improvements in healthcare policy legislation at the county level.

The ideological divide in confidence in science and participation in medical research

In the United States, the wide ideological divergence in public confidence in science poses a potentially significant problem for the scientific enterprise. We examine the behavioral consequences of this ideological divide for Americans' contributions to medical research. Based on a mass survey of American adults, we find that engagement in a wide range of medical research activities is a function of a latent propensity to participate. The propensity is systematically higher among liberals than among conservatives. A substantial part of this ideological divide is due to conservative Americans' lower confidence in science. These findings raise important issues for the recruitment of subjects for medical studies and the generalizability of results from such studies.

Using the General Social Survey - National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

OBJECTIVES

Fear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.

SETTING AND PARTICIPANTS

Data from the 1978-2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).

METHODS

GSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.

RESULTS

Among those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).

CONCLUSIONS

Research has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.

Political parties and mortality: The role of social status and personal responsibility

Previous research findings across a variety of nations show that affiliation with the conservative party is associated with greater longevity; however, it is thus far unclear what characteristics contribute to this relationship. We examine the political party/mortality relationship in the United States context. The goal of this paper is two-fold: first, we seek to replicate the mortality difference between Republicans and Democrats in two samples, controlling for demographic confounders. Second, we attempt to isolate and test two potential contributors to the relationship between political party affiliation and mortality: (1) socioeconomic status and (2) dispositional traits reflecting a personal responsibility ethos, as described by the Republican party. Graduate and sibling cohorts from the Wisconsin Longitudinal Study were used to estimate mortality risk from 2004 to 2014. In separate Cox proportional hazards models controlling for age and sex, we adjusted first for markers of socioeconomic status (such as wealth and education), then for dispositional traits (such as conscientiousness and active coping), and finally for both socioeconomic status and dispositional traits together. Clogg's method was used to test the statistical significance of attenuation in hazard ratios for each model. In both cohorts, Republicans exhibited lower mortality risk compared to Democrats (Hazard Ratios = 0.79 and 0.73 in graduate and sibling cohorts, respectively [p < 0.05]). This relationship was explained, in part, by socioeconomic status and traits reflecting personal responsibility. Together, socioeconomic factors and dispositional traits account for about 52% (graduates) and 44% (siblings) of Republicans' survival advantage. This study suggests that mortality differences between political parties in the US may be linked to structural and individual determinants of health. These findings highlight the need for better understanding of political party divides in mortality rates.

Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States

Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans' Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.

Political orientation, political environment, and health behaviors in the United States

Political orientation (Republican/Democrat and conservative/liberal) and political environment (geo-spatial political party affiliated voting patterns) are both associated with various health outcomes, including mortality. Modern disease etiology in the U.S. suggests that many of our health outcomes derive from behaviors and lifestyle choices. Thus, we examine the associations of political orientation and political environment with health behaviors. We used the Annenberg National Health Communication Survey (ANHCS) data, which is a nationally representative U.S. survey fielded continuously from 2005 through 2012. The health behaviors studied include health information search, flu vaccination, excessive alcohol consumption, tobacco consumption, exercise, and dietary patterns. Democrats/liberals had higher odds of cigarette smoking and excessive drinking compared to Republicans/conservatives. Whereas, Republicans/conservatives ate fewer servings and fewer varieties of fruit and vegetables; ate more high fat and processed foods; and engaged in less in-depth health information searches compared to Democrats/liberals. Also, conservatives had lower odds of exercise participation than liberals; whereas Republicans had lower odds of flu vaccination. Greater Republican vote share in the 2008 and 2012 presidential elections at the state and/or county levels was associated with higher odds of flu vaccination and smoking cigarettes and lower odds of avoiding fat/calories, avoiding fast/processed food, eating a variety of fruits and vegetables, and eating more servings of fruit. We use the distinct cognitive-motivational styles attributed to political orientation in discussing the findings. Health communication strategies could leverage these relationships to produce tailored and targeted messages as well as to develop and advocate for policy.

Political views of doctors in the UK: a cross-sectional study

BACKGROUND

Little is known about the political views of doctors in the UK despite doctors' importance in the functioning of the National Health Service (NHS).

METHODS

This is a survey-based, cross-sectional study in which we asked questions about voting behaviour in 2015 and 2017 UK general elections and 2016 referendum on leaving the European Union (EU) (Brexit), and questions relating to recent health policies.

RESULTS

1172 doctors (45.1% women) from 1295 responded to an online survey. 60.5% described their political views as 'left-wing' and 62.2% described themselves as 'liberal'. 79.4% of respondents voted to remain in the EU in the 2016 referendum compared with 48.1% of voters as a whole (χ²=819.8, p<0.001). 98.6% of respondents agreed that EU nationals working in the NHS should be able to remain in the UK after Brexit. The median score for the impact of Brexit on the NHS on a scale of 0 (worst impact) to 10 (best impact) was 2 (IQR=1-4). Most respondents agreed with the introduction of minimum alcohol pricing in the UK (73.9%), charging patients who are not eligible for NHS treatment for non-urgent care (70.6%) and protecting a portion of national spending for the NHS (87.1%). 65.8% thought there was too much use of NHS-funded private sector provision in their medical practice. Specialty, income and grade were associated with divergent opinions.

CONCLUSIONS

UK doctors are left-leaning and liberal in general, which is reflected in their opinions on topical health policy issues. Doctors in the UK voted differently from the general electorate in recent polls.

Political Ideology, Confidence in Science, and Participation in Alzheimer Disease Research Studies

BACKGROUND

Americans' confidence in science varies based on their political ideology. This ideological divide has potentially important effects on citizens' engagement with and participation in clinical studies of Alzheimer disease (AD).

METHODS

A probability sample of 1583 Americans was surveyed about their willingness to participate in longitudinal AD research and about their political attitudes. These survey results were compared with a survey of 382 participants in a longitudinal AD study at the Knight Alzheimer Disease Research Center.

RESULTS

Among Americans, more conservative ideology decreases willingness to participate in a hypothetical longitudinal cohort study of AD both directly and through its negative effect on confidence in science. The Knight Alzheimer Disease Research Center study participants expressed more liberal ideology and greater confidence in science than Americans in general. Of the survey respondents opposed to participation, over a quarter changed to neutral or positive if the study returned their research results to them.

CONCLUSIONS AND RELEVANCE

Clinical studies of AD are likely biased toward participants who are more liberal and have higher confidence in science than the general population. This recruitment bias may be reduced by lowering the trust demanded of participants through measures such as returning research results to participants.

Are political views related to smoking and support for tobacco control policies? A survey across 28 European countries

BACKGROUND

General political views are rarely considered when discussing public support for tobacco control policies and tobacco use. The aim of this study was to explore potential associations between political views, smoking and support for tobacco control policies.

METHODS

We analysed responses from 22,313 individuals aged ≥15 years from 28 European Union (EU) member states, who self-reported their political views (far-left [1-2 on a scale 1-10]; centre-left (3-4); centre (5-6); centre-right (7-8); and far-right (9-10) in wave 82.4 of the Eurobarometer survey in 2014. We ran multi-level logistic regression models to explore associations between political views and smoking, as well as support for tobacco control policies, adjusting for socio-demographic factors.

RESULTS

Compared to those placing themselves at the political centre, people with far-left political views were more likely to be current smokers (Odds Ratio [OR] = 1.13; 95% Confidence Interval [CI]: 1.01-1.26), while those in the centre-right were the least likely to smoke (OR = 0.84; 95% CI: 0.76-0.93). Similar associations were found for having ever been a smoker. Respondents on the left side of the political spectrum were more likely to support tobacco control policies and those on the centre-right were less likely to support them, as compared to those at the political centre, after controlling for smoking status.

CONCLUSIONS

General political views may be associated not only with support for tobacco control policies, but even with smoking behaviours, which should be taken into account when discussing these issues at a population level. Further research is needed to explore the implications of these findings.

County community health associations of net voting shift in the 2016 U.S. presidential election

Importance

In the U.S. presidential election of 2016, substantial shift in voting patterns occurred relative to previous elections. Although this shift has been associated with both education and race, the extent to which this shift was related to public health status is unclear.

Objective

To determine the extent to which county community health was associated with changes in voting between the presidential elections of 2016 and 2012.

Design

Ecological study with principal component analysis (PCA) using principal axis method to extract the components, then generalized linear regression.

Setting

General community.

Participants

All counties in the United States.

Exposures

Physically unhealthy days, mentally unhealthy days, percent food insecure, teen birth rate, primary care physician visit rate, age-adjusted mortality rate, violent crime rate, average health care costs, percent diabetic, and percent overweight or obese.

Main outcome

The percentage of Donald Trump votes in 2016 minus percentage of Mitt Romney votes in 2012 (“net voting shift”).

Results

Complete public health data was available for 3,009 counties which were included in the analysis. The mean net voting shift was 5.4% (+/- 5.8%). Of these 3,009 counties, 2,641 (87.8%) had positive net voting shift (shifted towards Trump) and 368 counties (12.2%) had negative net voting shift (shifted away from Trump). The first principal component (“unhealthy score”) accounted for 68% of the total variance in the data. The unhealthy score included all health variables except primary care physician rate, violent crime rate, and health care costs. The mean unhealthy score for counties was 0.39 (SD 0.16). Higher normalized unhealthy score was associated with positive net voting shift (22.1% shift per unit unhealthy, p < 0.0001). This association was stronger in states that switched Electoral College votes from 2012 to 2016 than in other states (5.9% per unit unhealthy, p <0.0001).

Conclusions and relevance

Substantial association exists between a shift toward voting for Donald Trump in 2016 relative to Mitt Romney in 2012 and measures of poor public health. Although these results do not demonstrate causality, these results suggest a possible role for health status in political choices.

State political ideology, policies and health behaviors: The case of tobacco

Anti-smoking campaigns are widely viewed as a success case in public health policy. However, smoking rates continue to vary widely across U.S. states and the success of anti-smoking campaigns is contingent upon states' adoption of anti-smoking policies. Though state anti-smoking policy is a product of a political process, studies of the effect of policies on smoking prevalence have largely ignored how politics shapes policy adoption, which, in turn, impact state health outcomes. Policies may also have different effects in different political contexts. This study tests how state politics affects smoking prevalence both through the policies that states adopt (with policies playing a mediating role on health outcomes) or as an effect modifier of behavior (tobacco control policies may work differently in states in which the public is more or less receptive to them). The study uses publicly available data to construct a time-series cross-section dataset of state smoking prevalence, state political context, cigarette excise taxes, indoor smoking policies, and demographic characteristics from 1995 to 2013. Political ideology is measured using a validated indicator of the ideology of state legislatures and of the citizens of a state. We assess the relationship between state political context and state smoking prevalence rates adjusting for demographic characteristics and accounting for the mediating/moderating role of state policies with time and state fixed effects. We find that more liberal state ideology predicts lower adult smoking rates, but that the relationship between state ideology and adult smoking prevalence is only partly explained by state anti-smoking policies.

The Effect of Anesthetic Type on Outcomes of Hip Fracture Surgery: A Nationwide Population-Based Study

Hip fractures are a global public health problem. During surgery following hip fractures, both general and regional anesthesia are used, but which type of anesthesia offers a better outcome remains controversial. There has been little research evaluating different anesthetic types on mortality and readmission rates for hip fracture surgery using nationwide population-based data.We used nationwide population-based data to examine the effect of anesthetic type on mortality and readmission rates for hip fracture surgery.Retrospective observational study.General acute care hospitals throughout Taiwan.A total of 17,189 patients hospitalized for hip fracture surgery in 2011.Generalized estimating equation models with propensity score weighting were performed after adjustment for patient, surgeon, and hospital characteristics to examine the associations of anesthesia type with 30-day all-cause mortality, 30-day all-cause readmission, and 30-day specific-cause readmission (including surgical site infection, sepsis, acute respiratory failure, acute stroke, acute myocardial infarction, acute renal failure, deep vein thrombosis, pneumonia, and urinary tract infection).Of 17,189 patients, 11,153 (64.9%) received regional anesthesia and 6036 (35.1%) received general anesthesia. Overall, the 30-day mortality rate was 1.7%, and the 30-day readmission rate was 12.3%. Regional anesthesia was not associated with decreased 30-day all-cause mortality (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.67-1.18, P = 0.409), but associated with decreased 30-day all-cause readmission and surgical site infection readmission relative to general anesthesia (OR 0.83, 95% CI 0.75-0.93, P = 0.001 and OR 0.69, 95% CI 0.49-0.97, P = 0.031).Regional anesthesia is not associated with 30-day mortality, but is associated with lower 30-day all-cause and surgical site infection readmission compared with general anesthesia for hip fracture surgery.