County-level association of COVID-19 mortality with 2020 United States presidential voting

A. S. Parzuchowski*, A. T. Peters, C. P. Johnson-Sasso, K. J. Rydland, J. M. Feinglass

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The objective of this study was to assess the association between United States county-level COVID-19 mortality and changes in presidential voting between 2016 and 2020. Study design: The study design is a 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 with 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 with 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.

Original languageEnglish (US)
Pages (from-to)114-117
Number of pages4
JournalPublic Health
StatePublished - Sep 2021


  • COVID-19
  • Presidential election
  • Public health
  • Voting

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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