In Simple Terms
People in states that voted for Trump have higher death rates overall than people in states that voted for Kamala Harris. The gap shows up in heart disease and cancer, too, but not in the same way for drug overdoses. These are differences between states—not proof that politics alone determines anyone’s health or how long they will live.
A Gap That Didn’t Appear Overnight
These figures point to a pattern that grew over many years, not a sudden shock tied to a single election. In 2001, the age-adjusted death rate in counties where the Republican candidate won the largest share of the vote was only about 2% higher than in counties that leaned toward the Democratic candidate. By 2019, the relative gap had grown to 16.1%.
The widening difference reflected more than a rise in deaths in one group. Death rates also fell more slowly in counties with a Republican majority. From 2001 to 2019, the rate dropped by 11.1% in those counties, compared with a 21.9% decline in counties with a Democratic majority. The divergence suggests that improvements in survival did not reach every community at the same pace.
In a more recent analysis, the research team compared deaths per 100,000 people, adjusted to account for differences in the age of each population. They looked at states where most voters chose Donald Trump in the 2024 election and states where most chose Kamala Harris, covering the period from 2016 to 2024. This classification reflects each state’s election result; it does not mean that everyone living there shares the same political views, or that an individual’s party affiliation determines their health.
Higher Death Rates Even After the Pandemic Peak
When Trump first won the presidency in 2016, the death rate from all causes was 776 deaths per 100,000 people in the states that voted for him in 2024, compared with 664 in the states that voted for Harris. That made the rate in the first group 17% higher.
The gap remained wide in 2024: 774 deaths per 100,000 in Trump-voting states, compared with 649 in Harris-voting states. The rate in the first group was therefore 19.2% higher. Notably, the figure for Trump-voting states in 2024 was close to its 2016 level, while the rate fell in the Harris-voting states. As a result, the distance between the groups grew even though the overall figure for the first group did not rise by a comparable amount.
The gap was widest in 2021, largely because COVID-19 deaths followed different patterns in the two groups. In states that leaned toward Harris, COVID-19 deaths peaked in 2020 at 86 per 100,000 people. In states that leaned toward Trump, deaths from the disease continued to rise through 2021, reaching 122 per 100,000. The pandemic deepened the divide, but it cannot by itself explain why the gap persisted after the most severe wave had passed.
Chronic Diseases Reveal a Persistent Divide
Comparing deaths from heart disease and cancer helps show whether the overall difference was simply a lingering effect of COVID-19. The gap also appears in major causes of death unrelated to the pandemic. From 2016 to 2024, heart disease deaths fell by 9.1% in Harris-voting states, while the decline in Trump-voting states was just 2.9%.
Cancer deaths moved in a similar direction, though the declines differed: 12.9% in the first group and 9.1% in the second. These figures do not mean that residents of any particular state are destined for a specific health outcome. They do show that progress in reducing deaths was uneven across the two groups. And because the gap persists for chronic diseases, understanding it requires looking at prevention, treatment, and living conditions—not just the years of the pandemic.
Many factors can shape a person’s chances of avoiding heart disease or cancer, or of having either condition detected and treated. Regular access to health care, the availability of preventive screenings, and the ability to afford treatment can all affect when a disease is diagnosed and what happens next. Social factors such as education, income, access to healthy food, and internet access can matter as well. The published comparison identifies differences but does not measure how much each factor contributes. It is best understood as a map of the problem, not proof of a single cause.
Drug Deaths Follow a Different Pattern
Deaths from drug overdoses do not follow the same pattern as overall deaths or deaths from heart disease and cancer. In 2016, overdose deaths were 18% higher—or 3.4 deaths per 100,000 people higher—in states that later voted for Trump than in Harris-voting states. In the years that followed, the group with the higher rate changed.
Overdose deaths in Trump-voting states peaked in 2021 at 35 per 100,000 people. In Harris-voting states, the peak came a year later, in 2022, at 32.5 per 100,000. Starting in 2023, the estimated rate in the Trump-voting group fell below the rate in the Harris-voting group. By 2024, the difference was very small: the rate was about 2% higher, or 0.4 deaths per 100,000 people higher, in Harris-voting states.
This shift is a reminder that the drug crisis is not confined to one region or one kind of community. It has spread and persisted in coastal and urban areas, as well as in the rural and industrial regions with which it was associated in earlier periods. Differences in debates over harm reduction and law enforcement also shape policy choices, but the numbers alone cannot identify any particular policy as the reason rates changed.
Health Coverage and the Conditions Around It
One area worth examining is how state policies affect access to insurance and treatment. Expanding Medicaid under the Affordable Care Act has been associated with lower death rates. Yet 10 states had not adopted the expansion, and all 10 voted for Trump in the 2024 election. That overlap does not prove that the lack of expansion alone explains the differences in deaths, but it makes insurance coverage an important part of the search for causes that can be changed.
People also lost coverage in greater numbers during Medicaid eligibility reviews in states that had not expanded the program. Work requirements or renewal procedures can interrupt coverage for people who need regular care if they cause them to lose insurance. This may be especially important for people managing chronic conditions, because delays in appointments or treatment can have effects that build over time.
Rural communities face other challenges, including difficulty reaching services and disproportionately frequent hospital closures. That can mean longer trips to get care or fewer options when someone needs urgent treatment or specialist follow-up. But rural areas are not all alike, and states are not made up of identical communities. It would be misleading to reduce them to a single political color or assume that every area faces the same obstacles.
Trust and Education Are Part of the Health Landscape
Health is also shaped by what people learn and by the choices available in daily life. Education is linked to factors that can change health risks, from smoking and obesity to heart disease risks and the likelihood of getting preventive screenings. Economic opportunities, access to healthy food and the internet, and the information people encounter through media and popular culture can also influence health behavior over time.
The differences seen during the COVID-19 pandemic raise another question: Is trust in public health institutions and health care increasingly divided along political lines? Differences in vaccination rates between states that leaned toward Trump and those that leaned toward Harris offer a clear sign of widening gaps in preventive behavior. But explaining those differences requires understanding where people get information, what shapes their trust, and how they have experienced institutions—not simply blaming a political group.
This is why it is important to distinguish correlation from causation. States with similar voting patterns may also resemble one another in other ways, such as the makeup of their populations, the availability of services, or their economic circumstances. The comparison does not say that voting causes deaths, and it does not prove that any one policy explains the differences. Instead, it reveals a pattern that calls for deeper analysis of communities, causes of death, and the resources available to people in different places.
The Bottom Line
Data from 2016 to 2024 show that the death rate from all causes remained higher in states that voted for Trump than in states that voted for Harris. The gap grew from 17% in 2016 to 19.2% in 2024, after widening further in 2021 as COVID-19 death rates diverged. Heart disease and cancer deaths declined faster in the Harris-voting group, while overdose deaths drew closer and, by 2024, were slightly higher in that same group.
The comparison was conducted by Brandon Yan, a physician and public health researcher affiliated with the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco; Maddie Feldmeier, a medical student at the university’s School of Medicine; and Renee Y. Hsia, a professor and vice chair of health services research in the university’s Department of Emergency Medicine. The findings should be treated as a sign of disparities that may be addressed, not as a fixed judgment about red or blue states. Expanding access to affordable care, strengthening rural services and behavioral health care, narrowing education gaps, and building trust in public health are all possible ways to reduce preventable deaths—whatever the voting map looks like.