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To investigate the associations of state gubernatorial party control and 2016 county-level presidential election preference on COVID-19 case and death rates in the United States. This was a secondary analysis of publicly available data. Data including county-level COVID-19 case and death counts through February 9, 2021, 2020 gubernatorial data, and county-level US Census Bureau data, Broadstreet area deprivation index, and 2016 presidential voting tallies were included. Negative binomial regression estimated the adjusted impact of each variable on COVID-19 case and death rates. A total of 3102 counties in the 48 continental United States plus Washington DC were included. County-level case and death rates were higher (12% and 22%, respectively) in Republican vs Democrat controlled states. Case and death rates were higher in counties voting Republican vs Democrat in 2016 and were modified by counties with median ages ≥ 50 years (54% increase in case rate and 91% increase in death rate). These data further support the need for prevention efforts to focus on public health while extricating guidance and prevention from political agendas. Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.


J Eden, J Salas, A Santos Rutschman, C G Prener, S L Niemotka, T L Wiemken. Associations of presidential voting preference and gubernatorial control with county-level COVID-19 case and death rates in the continental United States. Public health. 2021 Sep;198:161-163

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PMID: 34461448

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