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Comment by bjourne | Hacker News Reader

A key takeaway from the study is that Americans are getting healthier. Figure 5 shows a big drop in heart disease which must be due to more exercise and better eating habits. Also:

"In this national analysis, we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a Republican candidate, and these patterns were *consistent across subgroups (sex, race and ethnicity, urban-rural location).*"

I.e. many of the tried and true methods of "explaining away" a study's result does not apply.

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Not a doctor, but I believe that has to do with vastly improved survival rates for heart attacks. Hospitals have just gotten much better about it, by knowing that they have to act fast and having procedures in place to ensure that happens.

20 years ago a heart attack had a very high chance of death, even if you’re close to a hospital. These days, you’re much less likely to die if you get to a hospital / medic in time.

We've also made great reductions in smoking

> Current smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020 (CDC)

Didn't think about that. Regardless, the other decreases in AAMR are consistent with improved health. It cannot all be due to improved healthcare.

Why would that make Democratic voting counties see improvement but not Republican voting counties?

Not over a year but over decades I expect many indirect consequences of policies - like an underfunded energy grid fails and you cannot get your heart attack treatment timely... like a butterfly effect, not immediately visible but snowballing over years in the statistics.

I am skeptical, because almost all of the effect was due to white populations in republican counties (as they point out in the article). Other ethnicities apparently performed similarly across counties (again, as they point out). Seems a lot more likely that the decline of racism over the recent decades has just made poor white people look like poor other ethnicities (which we do see in the data). This also correlates with switching to vote Republican because you tend to vote populist when you are getting screwed and the Republicans have been the party of populism for at least the last decade. Anyways, the point is this study should be viewed with extreme skepticism because it is doubtful they captured all the external confounding factors.

There could be a bunch of reasons. Republicans tend to live in rural counties, republicans are less likely to trust doctors, republicans are further from hospitals, or democrats are more likely to afford healthcare and accept public assistance.

Or it could be completely irrelevant. Who knows? (Note: Looks like the article authors controlled for the distance from hospitals)

> Figure 5 shows a big drop in heart disease which must be due to more exercise and better eating habits.

Doubtful. Widespread use of statins, I should think, are a better match for that data.

It seems like everybody I know above 55 are on statins.

> sex, race and ethnicity, urban-rural location

What about income/economic class?

"A key takeaway from the study is that Americans are getting healthier."

Or perhaps just have better treatments?

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