Authors’ reply to Reed

We thank Reed for his response to our article.12 Reed suggests that increased mortality in Republican versus Democratic areas occurred because more Republican areas are rural with poor healthcare access. While Republican areas are more likely to be rural and rural areas do have higher mortality, as our previous work has demonstrated,3 the urban-rural gap does not account for our findings.In our analysis, we stratified Democratic and Republican areas by urban-rural status. Across all areas, Democratic areas experienced greater reductions in mortality from 2001 to 2019. Although Democratic rural areas had higher mortality than Republican areas in 2001, over the ensuing two decades, Democratic rural areas experienced a 16.5% relative improvement in mortality while Republican rural areas experienced only a 6.6% relative improvement in mortality—the smallest improvement of all areas studied. Therefore, Democratic rural areas experienced a 2.5 times greater relative reduction in mortality. This difference wasn’t just restricted to…
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