Conservative state policies generally associated with higher mortality

State policies in eight different policy domains, including gun safety, labor and tobacco, are associated with U.S. working-age mortality, according to a new study published this week in the open-access journal PLOS ONE by Jennifer Karas Montez of Syracuse University, U.S., and colleagues. They note that more conservative state policies were generally associated with higher mortality.

Americans die younger than people in most other high-income countries and within the United States life expectancy differs markedly across geographic areas. In 2019, it ranged from 74.4 years in Mississippi to 80.9 years in Hawaii.

In the new work, the researchers used data from the 1999–2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from cardiovascular disease (CVD), alcohol, suicide and drug poisoning among adults ages 25 to 64. They merged that data with annual state-level data on eight policy domains, where each state's policies were scored on a 0-to-1 conservative-to-liberal continuum.

The analysis revealed that more liberal policies on the environment, gun safety, labor, economic taxes and tobacco taxes were associated with lower mortality in each state. However, for marijuana, more conservative policies were associated with lower mortality.

Particularly strong associations were found between gun safety policies and suicide mortality among men; between labor policies and alcohol-induced mortality; and between economic and tobacco tax policies and cardiovascular disease mortality. Simulations suggested that changing all policies in all states to a fully liberal orientation could have saved 171,030 lives in 2019, while changing them to a fully conservative orientation may have cost 217,635 lives.

The authors conclude that the emergence of more conservative state policies in several domains and shifts in the share of the population living in states with these policies provide a partial explanation for the high and rising mortality among working-age Americans and the overall mortality disadvantage of the U.S. compared to other high-income countries.

The authors add, "U.S. state policies in recent decades may have contributed to the high and rising mortality rates of working-age adults. Changing state policies could prevent thousands of deaths every year from cardiovascular disease, suicide, alcohol, and drug poisoning."