Along party Lines: Examining the gubernatorial party difference in COVID-19 mortality rates in U.S. Counties

Aparna Lhila, Fares Alghanem

Research output: Contribution to journalArticlepeer-review


Drawing upon the literatures on risk factors for COVID-19 and the roles of political party and political partisanship in COVID-19 policies and outcomes, this study quantifies the extent to which differences in Republican- and Democrat-governed counties' observable characteristics explain the Republican - Democrat gap in COVID-19 mortality rate in the United States. We analyze the county COVID-19 mortality rate between February 1 and December 31, 2020 and employ the Blinder-Oaxaca decomposition method. We estimate the extent to which differences in county characteristics - demographic, socioeconomic, employment, health status, healthcare access, area geography, and Republican vote share, explain the difference in COVID-19 mortality rates in counties governed by Republican vs Democrat governors. Among 3,114 counties, Republican-governed counties had significantly higher COVID-19 mortality than did Democrat-governed counties (127 ± 86 vs 97 ± 80 per 100,000 population, p < 0.001). Results are sensitive to which weights are used: of the total gap of 30.3 deaths per 100,000 population, 12.8 to 20.5 deaths, or 42.2–67.7 %, are explained by differences in observable characteristics of Republican- and Democratic-governed counties. Difference in support for President Trump between Republican- and Democrat-governed counties explains 25 % of the additional deaths in Republican counties. Policies aimed at improving population health and lowering racial disparity in COVID-19 outcomes may also be correlated with reducing the partisan gap in COVID-19 mortality.

Original languageEnglish
Article number102142
JournalPreventive Medicine Reports
StatePublished - Apr 2023


  • COVID-19
  • COVID-19 mortality
  • Community health services
  • Decomposition
  • Democracy
  • Epidemiologic factors
  • Gubernatorial party
  • Health inequities
  • Health policy
  • Health politics
  • Inequality
  • Partisanship
  • Political partisanship
  • Public health
  • Republican vote share
  • Social activism
  • Social determinants of health
  • Sociodemographic factors
  • State government


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