State-Level Partisanship Strongly Correlates With Health Outcomes for US Children

Background: Multiple studies have demonstrated that poor childhood health can have negative physical, mental and economic effects on both individuals and populations. While pediatric health disparities have been explored along racial, gender, geographic and economic lines, little such attention has been paid to the influence of political partisanship. The Cook Partisan Voting Index (PVI) quantifies how strongly a state leans toward the Democratic or Republican Party in presidential elections compared to the nation. We set out to determine the correlation between childhood health outcomes and state-level partisanship using PVI.  Methods: 16 measures of childhood health were obtained from the CDC, U.S. Census Bureau, and U.S. Bureau of Labor Statistics for 2012-2016. PVI was averaged for every state for the same time period. Pearson's rho determined the correlation between PVI and each health outcome, using a Bonferroni adjustment of 0.003. Multiple regression was also conducted, adjusting for children without health insurance, primary care physicians, childhood poverty, and % non-white. We also compared childhood health in moderately Democratic and Republican states (5%-9.9% more Democratic/Republican than the national mean) and, similarly, for extremely Democratic and Republican states (10% or more Democratic/Republican than the national mean), using Kruskal-Wallis tests.   Findings: Democratic-leaning states had better outcomes for 7 of 16 health measures (all p<0.003, table 1). In the adjusted model, Democratic-leaning states had better outcomes for 9 of the 16 variables (all p<0.003, table 1). Among moderately-partisan states, no outcomes were statistically better in one group of states but extremely-Democratic states had superior outcomes for 5 variables (all p<0.003, table 2). No health outcomes were found to be significantly better in Republican-leaning states.  Interpretation: Multiple childhood health measures were statistically better in Democratic-leaning states compared to Republican counterparts. Future research should identify which state-level policies have led to such disparate health outcomes. Funding Statement: No funding was obtained for this project. Declaration of Interests: There are no conflicts of interest to report. Ethics Approval Statement: This study was exempt from IRB approval given that it used publicly available data.