A leading expert in health policy, Dylan H. Roby, PhD, associate professor of health, society, and behavior at the University of California, Irvine Program in Public Health, has over 25 years of expertise in health policy research, reform, and capacity-building in settings from Capitol Hill to academia. He has dedicated his career to addressing disparities in health care outcomes and focuses his research primarily on the health policy impacts on underserved populations, namely those served by public hospitals, community health centers, and Medicaid.
The Association Between COVID-19 Mortality and the County-Level Partisan Divide in the United States
Over 1 million Americans have died from COVID-19, a sobering fact that can be explained in part by the differences in pandemic response across red and blue states.
In early 2020, liberal states and localities were quick to heed the recommendations of their public health agencies by issuing masking and physical distancing restrictions to drive cases down. Conservative areas resisted adopting such measures.
Many Republican-leaning states criticized and ignored guidelines around masking mandates and, eventually, vaccine requirements, citing distrust of government and the belief that individual responsibility supersedes public health.
Those actions have led to fatal consequences, with more deaths shifting to rural and conservative areas.
My colleagues and I from the University of California, Irvine Program in Public Health, and the University of Maryland’s School of Public Health conducted an observational study comparing COVID-19 mortality data to U.S. counties’ voting behavior in the 2020 presidential election.
Our data analysis for Republican and Democratic-leaning counties revealed a positive relationship between county-level Republican vote share and county-level COVID-19 mortality.
Meaning that, counties who overwhelmingly supported Donald Trump experienced nearly 73 additional deaths per 100,000 people compared to Democratic counties. We also found that COVID-19 vaccine uptake on its own explains approximately 10 percent of the difference.
We hope two takeaways are clear: One, that we need enhanced, comprehensive public health approaches that provide multi-pronged policy solutions beyond simply focusing on vaccines. This study does not conclude that Republicans are more likely to die from COVID, but that people living in Republican areas are more likely to die – a likely proxy for compliance with public health guidelines.
And two, that vulnerable people living in Republican areas, regardless of their politics, are more likely to die from COVID due to the political beliefs, compliance with public health measures, and health behaviors of their neighbors.