Political orientation and traffic deaths: An ecological analysis

Introduction: Americans have some of the highest traffic fatality risks and the most polarized national politics compared to other democracies. This study tested whether traffic fatality risks in the United States are associated with state-level presidential voting patterns. Methods: In this cross-sectional ecological analysis, we examined state-level popularity of the Republican presidential candidate with traffic fatality data from the National Highway Traffic Safety Administration. The analysis covered seven presidential elections from 1996 to 2020. Sensitivity analyses examined voter turnout as a non-partisan predictor, three health behaviors as negative control outcomes, and three medical causes of death as positive control outcomes. Results: A higher share of votes for the Republican presidential candidate in 2020 was correlated with higher traffic fatality risks (r = 0.63, p < 0.001). On average, a 1% increase in Republican popularity was associated with 20 extra traffic deaths per state annually (95% confidence interval = 13 to 28). This pattern replicated in six prior presidential elections and persisted across all ages, both sexes, diverse road users, and irrespective of alcohol influence. Conclusions: American states with a higher share of votes for the Republican presidential candidate tend to have higher traffic fatality risks. Clinicians, patients, and policymakers living in Republican states should be extra careful driving and at other times traveling on public roads in the community.