June 2021
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3 Reads
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7 Citations
Public Health
Objective To assess the association between United States county-level Covid-19 mortality and changes in presidential voting between 2016 and 2020. Study design County-level ecological study. Methods We analysed county-level population-weighted differences in partisan vote change, voter turnout, and sociodemographic and health status characteristics across pre-election Covid-19 mortality quartiles. We estimated a population-weighted linear regression of the 2020-2016 Democratic vote change testing the significance of differences between quartiles of Covid-19 mortality, controlling for other county characteristics. Results The overall change in the 2020-2016 Democratic vote was +2.9%, but ranged from a +4.3% increase in the lowest mortality quartile counties to +0.9% in the highest mortality quartile counties. Change in turnout ranged from +9.1% in the lowest mortality counties to only +6.2% in highest mortality counties. In regression estimates, the highest mortality quartile was associated with a -1.26% change in the Democratic 2020-2016 vote compared to the lowest quartile (p<0.001). Conclusions Higher county-level Covid-19 mortality was associated with smaller increases in Democratic vote share in 2020 compared to 2016. Possible explanations to be explored in future research could include fear of in-person voting in heavily Democratic, high-mortality counties, fear of the economic effects of perceived Democratic support for tighter lockdowns and stay-at-home orders, and general exhaustion that lowered political participation in hard-hit counties.