Associations of presidential voting preference and gubernatorial control with county-level COVID-19 case and death rates in the continental United States

OBJECTIVE: 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. STUDY DESIGN: This was a secondary analysis of publicly available data. METHODS: 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. RESULTS: 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). CONCLUSIONS: These data further support the need for prevention efforts to focus on public health while extricating guidance and prevention from political agendas.