Residents of Republican counties more likely to die of COVID-19 regardless of own political beliefs, study finds

Residents in majority Republican counties were more likely to die of COVID-19 than those in Democratic counties, a new study found.

The study was published in the latest Health Affairs issue. It looked at per capita COVID-19 mortality through October 2021 by partisanship and controlled for race, ethnicity and other factors that might influence infection risk. It found majority Republican counties had nearly 73 extra deaths per 100,000 population compared to majority Democratic counties. 

Approximately 10% of the difference is explained by vaccination rates, according to the study. This difference was already apparent before vaccines first became available. After that, the split was even more pronounced between Republican and Democratic counties, the study found. It is possible these differences increased even more dramatically during the omicron variant wave, when vaccination rate differences may have been even more influential. 

Deaths in Republican-majority counties were not limited to the unvaccinated or those not following public health measures, the researchers emphasized. For instance, healthcare workers, the immunocompromised and the elderly were also more likely to die from COVID-19 during the studied time frame, regardless of their political beliefs. A lack of implementation or compliance with public health measures "played a significant role" in this difference, the study said, which was likely driven by individual political beliefs. 

For instance, local leaders may have avoided implementing policies to fight the virus because of pressure. Even if they did, compliance would have faced an uphill battle. It's likely, the study said, that Democratic counties benefited more from these mandates because residents were more willing to comply with them.

"Political ideology has long been known to affect health-related behaviors, attitudes, and risk perception," the study authors wrote.

Structural and social differences in conservative areas were likely associated with a higher risk of death, the researchers noted. 

“It is likely that individual political beliefs compromise the effectiveness of local policies and public health measures,” the study concluded. “At the root of conservative ideologies is the notion that health is an individual responsibility that government should have little to no power in regulating or intervening.”

The study advocated for the federal government to invest in health communication, healthcare workers and other support to increase vaccine uptake. Requiring masks and other protective measures could also help minimize deaths in places of limited vaccine uptake. 

“People living in states and counties with more conservative voters and less faith in the public health apparatus are dying at higher rates from a disease that could be characterized as largely preventable,” the authors wrote.