Table 3.
Baseline rates, joinpoint regression analysis of trends in health outcomes stratified by state-level political metrics, and rate differences, adjusted for poverty, for 50 US states and the District of Columbia (2012–2024).
| Health outcome | Political metric | Baseline health outcome (2012), value (95% CI) | Inflection points (year, 95% CI) and slope (95% CI) | Comparison of absolute rate differences during presidential election years, adjusted for poverty, rate difference (95% CI) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Interval 1 | Interval 2 | Interval 3 | 2012 | 2016 | 2020 | 2024 | ||||||
| Estimate | Slope | Inflection point | Slope | Inflection point | Slope | |||||||
| Premature mortality rate (age-standardized death rate for persons <65 years per 100 000 persons) | State liberalism index | Most liberal: consistently in top tercile | 135.9 (107.4, 164.3) | 2.8 (1.3, 4.4) | 2018 (2015, 2018) | 17. 6 (14. 9, 20.3) | 2021 (2021, 2022) | −19.4 (−22.6, −16.3) | [referent] | [referent] | [referent] | [referent] |
| Not consistently in either top or bottom tercile | 172.3 (146.4, 198.2) | 2.9 (1. 6, 4.2) | 2018 (2015, 2018) | 21.8 (19.4, 24.2) | 2021 (2021, 2022) | −26.2 (−28.8, −23.5) | 36.4 (11.9, 61.0) | 36.5 (12.6, 60.5) | 104.0 (79.9, 128.1) | 29.1 (−15.7, 73.9) | ||
| Most conservative: consistently in bottom tercile | 175.9 (142. 9, 208.8) | 12.5 (11.4, 13.6) | 2018 (2015, 2018) | 29.0 (25.6, 32.4) | 2021 (2021, 2022) | −29.5 (−32.9, −26.2) | 40.0 (12.0, 68.1) | 78.6 (51.1, 106.2) | 120.8 (91.9, 149.8) | 102.0 (72.2, 131.8) | ||
| State trifecta | Consistently Democratic | 173.7 (126.3, 221.1) | 1.5 (−1.1, 4.1) | 2018 (2016, 2018) | 17.7 (12.8, 22.7) | 2021 (2021, 2021) | −19.8 (−25.6, −14.0) | [referent] | [referent] | [referent] | [referent] | |
| Mixed | 195.6 (168.3, 222.9) | 2.2 (1.1, 3.4) | 2018 (2015, 2018) | 21.9 (19.9, 23.9) | 2021 (2021, 2022) | −22.7 (−24.9, −20.5) | 21.9 (−23.8, 67.7) | 24.9 (−20.1, 69.8) | 99.5 (54.4, 144.7) | 30.1 (−53.3, 113.5) | ||
| Consistently Republican | 229.5 (196.0, 263.0) | 1.4 (−0.1, 2.9) | 2018 (2015, 2018) | 27.0 (24.4, 29.7) | 2021 (2021, 2022) | −29.9 (−32.9, −26.9) | 55.8 (7.7, 103.1) | 55.4 (7.7, 103.1) | 73.8 (26.0, 121.6) | 52.8 (3.7, 101.9) | ||
| US House: DW-Nominate index | Most liberal: consistently in top tercile | 161.3 (128.8, 193.9) | 1.5 (−0.5, 3.5) | 2018 (2015, 2018) | 15.6 (12.7, 18.6) | 2021 (2021, 2022) | −16.6 (−20.0, −13.1) | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 213.0 (185.2, 240.7) | 1.9 (0.8, 3.0) | 2018 (2015, 2018) | 26.0 (24.0, 28.0) | 2021 (2021, 2022) | −28.6 (−30.8, −26.4) | 51.6 (22.3, 80.9) | 49.6 (20.8, 78.5) | 122.2 (93.3, 161.2) | 43.5 (−7.3, 94.4) | ||
| Most conservative: consistently in bottom tercile | 213.2 (174.5, 251.8) | 2.4 (0.8, 4.0) | 2018 (2015, 2018) | 24.0 (20.3, 27.6) | 2021 (2021, 2022) | −26.0 (−30.2, −21.9) | 51.8 (12.7, 91.0) | 48.3 (9.8, 86.7) | 63.1 (24.5, 101.7) | 43.1 (3.5, 82.7) | ||
| US Senate: DW-Nominate index | Most liberal: consistently in top tercile | 160.4 (125.6, 195.1) | 2.1 (0.3, 3.4) | 2018 (2015, 2018) | 14.8 (11.4, 18.1) | 2021 (2021, 2022) | −15.3 (−19.2, −11.3) | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 198.6 (171.2, 226.0) | 2.6 (1.5, 3.8) | 2018 (2015, 2018) | 24.0 (21.9, 26.0) | 2021 (2021, 2022) | −25.9 (−28.2, −23.6) | 38.3 (5.2, 71.4) | 40.5 (8.0, 73.1) | 110.8 (78.1, 143.5) | 37.2 (−20.5, 95.0) | ||
| Most conservative: consistently in bottom tercile | 225.2 (191.7, 258.7) | 1.0 (−0.5, 2.5) | 2018 (2015, 2018) | 27.5 (24.7, 30.3) | 2021 (2021, 2022) | −30.4 (−33.5, −27.2) | 64.8 (27.9, 101.8) | 60.7 (24.3, 97.0) | 84.1 (47.6, 120.5) | 51.4 (14.1, 88.8) | ||
| Infant mortality: deaths per 1000 live births | State liberalism index | Most liberal: consistently in top tercile | 4.6 (3.9, 5.4) | 0.4 (0.2, 0.5) | 2022 (2014, 2022) | 0.3 (0.1, 0.4) | — | — | [referent] | [referent] | [referent] | [referent] |
| Not consistently in either top or bottom tercile | 5.2 (4.4, 5.9) | −0.0 (−0.1, 0.0) | 2022 (2015, 2022) | 0.4 (0.2, 0.5) | — | — | 0.5 (−0.0, 1.1) | 0.8 (0.2, 1.3) | 1.0 (0.4, 1.5) | 1.6 (0.9, 2.3) | ||
| Most conservative: consistently in bottom tercile | 6.1 (5.2, 7.0) | −0.0 (−0.1, −0.0) | 2021 (2014, 2022) | 0.1 (0.0, 0.2) | — | — | 1.5 (0.8, 2.1) | 1.6 (1.0, 2.2) | 1.7 (1.1, 2.3) | 1.6 (−0.5, 3.8) | ||
| State trifecta | Consistently Democratic | 5.1 (3.9, 6.3) | −0.1 (−0.1, −0.0) | 2022 (2014, 2022) | 0.2 (−0.2, 0.5) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Mixed | 5.2 (4.4, 6.0) | −0.1 (−0.1, −0.0) | 2021 (2017, 2022) | 0.2 (0.1, 0.3) | — | — | 0.1 (−0.9, 1.2) | 0.2 (−0.8, 1.2) | 0.3 (−0.7, 1.3) | 0.6 (−0.5, 1.7) | ||
| Consistently Republican | 5.9 (4.9, 7.0) | 0.0 (−0.1, 0.1) | 2016 (2014, 2017) | −0.1 (−0.2, −0.0) | 2020 (2019, 2022) |
0.1
(0.0, 0.2) |
0.9 (−0.3, 2.0) | 1.3 (0.2, 2.3) | 1.2 (0.1, 2.2) | 1.4 (0.3, 2.6) | ||
| US House: DW-Nominate index | Most liberal: consistently in top tercile | 4.3 (3.5, 5.2) | −0.1 (−0.1, −0.0) | 2022 (2014, 2022) | 0.3 (0.1, 0.5) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 5.3 (4.5, 6.1) | −0.1 (−0.1, −0.0) | 2021 (2014, 2022) | 0.1 (0.1, 0.2) | — | — | 1.0 (0.4, 1.6) | 1.1 (0.5, 1.7) | 1.2 (−0.7, 3.2) | 1.1 (0.4, 1.8) | ||
| Most conservative: consistently in bottom tercile | 4.9 (3.9, 5.9) | 0.1 (0.0, 0.2) | 2016 (2015, 2017) | −0.1 (−0.2, −0.0) | 2021 (2019, 2022) |
0.3
(0.1, 0.4) |
0.6 (−0.3, 1.4) | 1.5 (0.7, 2.3) | 1.4 (0.6, 2.2) | 1.7 (0.8, 2.6) | ||
| US Senate: DW-Nominate index | Most liberal: consistently in top tercile | 4.7 (3.8, 5.6) | −0.1 (−0.1, −0.0) | 2022 (2014, 2022) | 0.3 (0.0, 0.5) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 5.5 (4.7, 6.4) | −0.1 (−0.1, −0.0) | 2021 (2014, 2022) | 0.2 (0.1, 0.3) | — | — | 0.8 (0.1, 1.5) | 0.9 (0.2, 1.6) | 1.0 (−0.6, 2.6) | 1.1 (0.3, 1.9) | ||
| Most conservative: consistently in bottom tercile | 6.0 (5.0, 7.0) | −0.0 (−0.1, 0.1) | 2016 (2014, 2017) | −0.1 (−0.2, 0.0) | 2020 (2018, 2022) | 0.1 (0.0, 0.2) | 1.2 (0.4, 2.1) | 1.5 (0.7, 2.3) | 1.5 (0.7, 2.3) | 1.6 (0.8, 2.5) | ||
| Percentage lacking health insurance (adults aged 35–64) | State liberalism index | Most liberal: consistently in top tercile | 11.8 (9.4, 14.3) | −2.0 (−2.2, −1.7) | 2015 (2014, 2016) | 0.0 (−0.1, 0.2) | — | — | [referent] | [referent] | [referent] | [referent] |
| Not consistently in either top or bottom tercile | 14.6 (12.4, 16.9) | −2.1 (−2.3, −1.9) | 2015 (2014, 2017) | 0.0 (−0.1, 0.1) | — | — | 2.8 (0.7, 4.8) | 2.2 (0.1, 4.2) | 1.6 (−1.2, 4.3) | 2.0 (−0.5, 4.6) | ||
| Most conservative: consistently in bottom tercile | 17.2 (14.3, 20.1) | −1.9 (−2.2, −1.6) | 2015 (2014, 2020) | 0.0 (−0.1, 0.1) | — | — | 5.4 (3.0, 7.7) | 5.7 (3.3, 8.1) | 6.0 (2.8, 9.1) | 5.4 (3.0, 7.8) | ||
| State trifecta | Consistently Democratic | 10.8 (7.3, 14.4) | −2.0 (−2.4, −1.5) | 2015 (2014, 2016) | 0.1 (−0.1, 0.3) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Mixed | 13.0 (10.7, 15.2) | −2.1 (−2.3, −1.9) | 2015 (2014, 2017) | 0.0 (−0.1, 0.1) | — | — | 2.1 (−1.2, 5.4) | 1.7 (−1.6, 5.1) | 1.3 (−3.0, 5.7) | 1.6 (−2.6, 5.7) | ||
| Consistently Republican | 15.6 (12.8, 18.3) | −1.7 (−1.9, −1.4) | 2015 (2014, 2019) | 0.0 (−0.1, 0.2) | — | — | 4.7 (1.2, 8.2) | 5.9 (2.4, 9.5) | 7.2 (2.5, 11.8) | 5.7 (2.1, 9.4) | ||
| US House: DW-Nominate index | Most liberal: consistently in top tercile | 11.8 (9.1, 14.5) | −1.7 (−2.1, −1.4) | 2015 (2014, 2016) | 0.1 (−0.1, 0.2) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 14.5 (12.1, 16.9) | −2.1 (−2.2, −1.9) | 2015 (2014, 2017) | 0.0 (−0.0, 0.2) | — | — |
2.7
(0.4, 5.0) |
2.4 (0.1, 4.7) | 2.2 (−0.8, 5.1) | 2.3 (−0.5, 5.1) | ||
| Most conservative: consistently in bottom tercile | 15.2 (12.0, 18.4) | −2.0 (−2.3, −1.7) | 2015 (2014, 2019) | 0.0 (−0.1, 0.2) | — | — | 4.7 (1.6, 7.8) | 4.6 (1.5, 7.6) | 5.7 (1.8, 9.7) | 4.4 (1.2, 7.5) | ||
| US Senate: DW-Nominate index | Most liberal: Consistently in top tercile | 11.5 (8.8, 14.2) | −2.0 (−2.3, −1.7) | 2015 (2014, 2016) | 0.1 (−0.0, 0.2) | — | — | [referent] | [referent] | [referent] | [referent] | |
| Not consistently in either top or bottom tercile | 14.3 (12.0, 16.6) | −2.1 (−2.3, −1.7) | 2015 (2014, 2018) | 0.0 (−0.0, 0.2) | — | — | 2.7 (0.3, 5.1) | 2.3 (−0.1, 4.7) | 1.8 (−1.4, 5.0) | 2.0 (−0.9, 5.0) | ||
| Most conservative: consistently in bottom tercile | 17.5 (14.7, 20.2) | −1.7 (−2.1, −1.4) | 2015 (2014, 2020) | 0.0 (−0.1, 0.2) | — | — | 5.9 (3.2, 8.6) | 5.6 (2.9, 8.4) | 5.4 (1.8, 8.9) | 5.3 (2.5, 8.0) | ||
Values were adjusted for both childhood poverty and poverty among persons aged ≥65 years; for the rate comparisons, the referent group for the rate difference is most liberal or Democratic trifecta, indicated by a value of [referent] for rate difference; DC (District of Columbia) is included solely for the state liberalism index analyses; and slopes and rate differences whose 95% CIs exclude 0 are shown in bold type.