In this week’s JAMA Internal Medicine Wallace et al examined death rates by voter registration in Ohio and Florida during the first 21 months of the COVID pandemic. They found that there was no differential death rate by partisan identity when there were no vaccines. However, as soon as vaccines became widely available to the adult population differential death rates were observed:
After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from −0.9 percentage point (95% PI, −2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio.
Previous researchers had found substantial differences in death rates at the aggregate county level. This study looks at individual level effects within counties and found substantial variation.
We know from ACA research that partisanship is one hell of a predictor of purchase of regulated health insurance. Republicans, for a given level of health and income, were less likely to purchase a policy than Democrats. We know political identity is important in the ACA context, and now we know it has huge mortality differentials in the COVID vaccination context.
I think we really need to get our head around partisan identity as a social determinant of health as I would be shocked if these two examples are isolated examples.