Political ideology and COVID-19 health outcomes

The higher the exposure to political conservatism, the higher the COVID-19 mortality rates and stress on hospital intensive care unit (ICU) capacity, according to a new study from Harvard T.H. Chan School of Public Health.

"Before our study, research on how political ideology affects COVID-19 looked solely at voters' political lean; we expanded on that research to investigate associations of COVID-19 outcomes with the voting records of federal elected representatives and the concentration of political party power at the state level. The point is not partisan analysis, but rather to understand how politics, and political polarization, are affecting population health," said Nancy Krieger, professor of social epidemiology at Harvard T.H. Chan School of Public Health and corresponding author of the study.

The study will be published online in The Lancet Regional Health—Americas on November 1, 2022.

Little prior research had looked at COVID-19 health outcomes in relation to U.S. congressional districts. The researchers analyzed data on COVID-19 mortality rates and stress on ICU capacity from April 2021 to March 2022, a period when adult vaccines were available, across all 435 U.S. Congressional districts. They examined three exposure variables that had not been used previously in COVID-19 research: the political ideology of U.S. elected members of Congress, as measured by their overall voting records; their votes on four key COVID-19 relief bills; and "state trifectas," the concentration of political power at the State level, defined as the governor, House, and Senate, all under the control of one party.

The study found that the higher the exposure to conservatism on each political metric, the higher the COVID-19 age-standardized mortality rates, even after adjusting for the district's social characteristics, voters' political lean, and vaccination rates. The same relationship held true for stress on hospital ICU capacity.

For COVID-19 mortality rates, for example, models controlling for political and social metrics and vaccination rates showed that Republican trifectas were, respectively, 11% higher and conservative voter political lean 26% higher.

"Our study offers new approaches to analyzing political determinants of COVID-19 metrics—such as mortality, illness, or vaccination rates—as one component of analyzing political accountability for populations' COVID-19 burdens. It also points to the importance of analyzing political metrics in relation to population health outcomes more generally," said Krieger.

There was no funding for the study from any agency in the public, commercial, or not-for-profit sector.