People living in Republican counties more likely to die from COVID

The partisan divide in the United States throughout the COVID-19 pandemic stretched beyond differences in attitudes about masking, social distancing and vaccines. According to a new study led by University of Maryland researchers and senior author on the paper Dylan H. Roby, PhD, an associate professor of health, society, and behavior at UCI Public Health, it also is tied to a clear difference in mortality rates from the virus.

In the study, published today in the June issue of Health Affairs, researchers compared the number of COVID-19 deaths through October 2021 with counties’ voting behavior in the 2020 presidential election. Their analysis controlled for other characteristics likely to influence COVID-19 transmission and mortality such as age, race/ethnicity, chronic disease and access to health care.

Their analysis found that Republican counties (where 70% or more voted Republican in the 2020 presidential election) experienced 72.94 more COVID-19 deaths per 100,000 people compared to Democratic counties (where fewer than 30% voted Republican in the 2020 presidential election).

Authors explained that people living in states and counties with more conservative voters and less faith in the public health system are dying at higher rates from this highly preventable disease. Their study also found that COVID-19 vaccine uptake only explained approximately 10 percent of the difference in mortality between red and blue counties, an impact the researchers expected to be much greater. This indicates a need for enhanced public health approaches that go beyond focusing solely on vaccines and instead communicate the need for comprehensive, multi-pronged policy solutions.

The disparity in mortality rates between Republican and Democratic counties was due largely to structural, policy and behavioral differences in the more conservative counties.

“Voting behaviors at the county level are likely to represent the compliance or lack of compliance with mask mandates, vaccine uptake and use of other protective policies to mitigate the impacts of the pandemic,” Roby said.

Since the United States surpassed 1 million deaths from COVID-19 earlier this spring and infection rates are up in many states, these policies could help prevent infections and reduce the chance of serious outcomes among those who do get infected, including death or the lingering symptoms known as long COVID, which may affect as many as 30% of people who have been infected.

“The impact of partisanship doesn’t only impact people of one political stripe,” said corresponding author Neil Jay Sehgal, PhD, assistant professor of health policy and management at the University of Maryland School of Public Health. “Not everyone who lives in a Republican county votes Republican. In very few of these counties was there 70% or greater vote share. Even in the reddest counties, you have people who aren’t able to vote or aren’t able to leave, and yet are subject to the policies and behaviors that surround them. If they are older, immunocompromised or an essential worker, that puts them at greater risk of death or disability.”


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