Voters with shorter life expectancy were more likely to plump for Donald Trump, according to new research.
Ever since the business magnate became president of the United States experts have sought to understand how he defied the polls despite any political experience.
Now a study has identified a direct link between decision making and the nation’s growing geographic health gap.
In areas with slowing, or declining, life expectancy most people chose Trump, the Republican nominee. But elsewhere, the majority picked the Democratic candidate Hillary Clinton.
Jacob Bor, assistant professor of global health at Boston University, said: “In the last 30 years, there’s been a sharp divergence in life expectancy across US counties.
“Some counties have gained a full decade of life expectancy. Others have really been left behind, with zero gains or even falling life expectancy in this period.”
The analysis found last year’s unexpected result was down to Trump winning more votes in counties that have seen lower gains in life expectancy.
It examined county-level data on voting patterns from the 2008 and 2016 presidential elections and on life expectancy for people born from 1980 to 2014.
Over this time life expectancy rose by about five years – but the gains were not even, reports the American Journal of Public Health.
Prof Bor said counties in which life expectancy rose less than three years saw a nearly 10 percent increase in the Republican vote share between 2008 and 2016.
In counties where life expectancy rose more than seven years, Democrats saw a 3.5 percent rise.
Life expectancy trends were also connected to voter turnout with the total number of votes for the two major parties soaring by 1.3 million in counties with above-average life expectancy gains.
But they fell by 1.9 million in those with below-average gains – the counties more likely to go for Trump.
Overall – from 2008 to 2016 – Republicans lost 67,000 votes in counties with above-average life expectancy trends – but gained 3.1 million votes in the rest.
Democrats gained 1.4 million and lost 5 million in these counties a 14 percent relative decline.
Prof Bor said: “In the 2016 election – in counties that had been left behind in life expectancy gains – residents abandoned the Democratic Party, voting for Trump or not voting at all. What we now need to understand is why.”
He stressed the association may not be causal and there could be other explanations such as the roles of race and economic marginalisation.
But Prof Bor said: “Regardless of the causes of this relationship the data show people in counties that voted for Trump are hurting , and not just metaphorically.
“The findings signal an important opportunity for policymakers to try to address the health needs of these populations.”
He said since coming to power Trump has suggested repealing the Affordable Care Act – Barack Obama’s health care law – and cuts to health insurance for the poor.
Prof Bor also pointed out proposed reductions in health research, public health surveillance, environmental protection, occupational safety and social programs – all of which can affect life expectancy.
He said: “When will the Trump administration and Republicans in Congress respond to the health needs of those who put them into power and enact policies that will support population health?”