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<p>Political orientation, particularly Republican vote share, has become a key predictor of COVID-19 mortality in the U.S. Our study tests whether and when political orientation is associated with COVID-19 mortality by examining changes in the Republican Party’s stance across four pandemic waves. We analyze COVID-19 mortality across 3,108 U.S. counties over 60 two-week periods using multilevel negative binomial regression. Dose-response and falsification tests evaluate the robustness and specificity of observed associations. During Wave 1 (Feb–Aug 2020), Republican vote share had no significant association with COVID-19 mortality. However, in Waves 2–4, as Republican rhetoric turned against public health measures, the association strengthened significantly (Wave 2 IRR = 1.28; Wave 3 IRR = 1.14; Wave 4 IRR = 1.17). Dose-response and falsification tests provided mixed evidence for a causal link, with increased Republican vote associated with greater mortality, but Republican vote also correlated with other health outcomes. Together these results suggest a strong association between Republican vote and COVID-19 mortality when Republican attitudes hardened against public health measures, and suggests political, cultural, and social factors can have a strong impact on public heath outcomes.</p>

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Political Orientation and Public Health: The Evolving Relationship Between Republican Vote Share on COVID-19 Mortality Across Pandemic Waves

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Jie Zhuo,
  • Nicholas Harrigan

摘要

Political orientation, particularly Republican vote share, has become a key predictor of COVID-19 mortality in the U.S. Our study tests whether and when political orientation is associated with COVID-19 mortality by examining changes in the Republican Party’s stance across four pandemic waves. We analyze COVID-19 mortality across 3,108 U.S. counties over 60 two-week periods using multilevel negative binomial regression. Dose-response and falsification tests evaluate the robustness and specificity of observed associations. During Wave 1 (Feb–Aug 2020), Republican vote share had no significant association with COVID-19 mortality. However, in Waves 2–4, as Republican rhetoric turned against public health measures, the association strengthened significantly (Wave 2 IRR = 1.28; Wave 3 IRR = 1.14; Wave 4 IRR = 1.17). Dose-response and falsification tests provided mixed evidence for a causal link, with increased Republican vote associated with greater mortality, but Republican vote also correlated with other health outcomes. Together these results suggest a strong association between Republican vote and COVID-19 mortality when Republican attitudes hardened against public health measures, and suggests political, cultural, and social factors can have a strong impact on public heath outcomes.