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Implications of Red State/Blue State Differences in COVID-19 Death Rates

Author(s): Mary L. Adams

This study used linear regression to explore state COVID-19 death rates and associated factors pre- and post- vaccine availability to better understand options for preventing future deaths. The ratio of red to blue state (based on voting in the 2016 presidential election) deaths/million was 1:1 pre-4/19/2021 (assumed date vaccines available) and 1.7:1 between 4/19 and 2/28/2022. Prior to 4/19/2021, models with Northeast region, red vs. blue states, and black race or obesity had highest R2 of up to 0.335. Adjusted betas from linear regression showed region and red vs. blue states tied for having the strongest effect on deaths rates. After 4/19/2021, the model with state vaccination rates, the number of chronic conditions (obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and asthma) among state adults, and red vs. blue states had highest R2 of 0.62. Adjusted betas post 4/19/2021 showed vaccination rates had the strongest effect on death rates while red vs. blue states explained 60% of the difference in state death rates vs. 46% explained by just vaccination rates. The 3 factors were highly associated, with mean vaccination rates ~10% higher in blue states and 5 of 6 chronic conditions more common among adults in red states. Before vaccines were available, reducing obesity appeared to be the best among modifiable options for reducing deaths while increasing vaccination rates particularly in red states appeared the best option for preventing deaths later in the pandemic.

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