State-level political partisanship strongly correlates with health outcomes for US children

Megan Paul, Ruya Zhang, Bian Liu, Payam Saadai, Brian A. Coakley

Research output: Contribution to journalArticlepeer-review


The Cook Partisan Voting Index (PVI) determines how strongly a state leans toward the Democratic or Republican Party in US presidential elections compared to the nation. We set out to determine the correlation between childhood health outcomes and state-level partisanship using PVI. Sixteen measures of childhood health were obtained from several US governmental agencies for 2003–2017. The median PVI for every state was calculated for the same time period. Pearson’s rho determined the correlation between PVI and each health outcome. Multiple regression was also conducted, adjusting for educational attainment and percentage of non-White residents. 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 Wilcoxon tests. For all 16 health measures, the median values in Democratic-leaning states represented better outcomes than Republican-leaning states (9/16 had a beta value for linear regression associated with P < 0.05). When compared to Republican states, the median values in moderately Democratic states represented better outcomes for 14 of 16 health measures (9/14 associated with P < 0.05). Similarly, the median values for extremely Democratic states represented better outcomes with regard to all 16 health measures, when compared to Republican-leaning states (8/16 associated with P < 0.05). Conclusions: Democratic-leaning states displayed superior outcomes for multiple childhood health measures when compared to Republican counterpart states. Future research should investigate the significance of these findings and attempt to determine which state-level policies may have contributed to such disparate health outcomes.What is Known:• In the United States, many health disparities exist among children along racial, economic and geographic lines.• Many US states lean strongly towards either the Democratic or Republican political parties in federal elections.What is New:• Trends for multiple measures of childhood health vary in association with the political partisanship of the state being examined.• Multiple barometers of childhood health are superior in Democratic-leaning states, while no measures are better in Republican-leaning states.

Original languageEnglish (US)
JournalEuropean Journal of Pediatrics
StateAccepted/In press - 2021


  • Disparities
  • Equity
  • Partisanship
  • Pediatrics
  • Public Health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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