The association of voter turnout with county-level coronavirus disease 2019 occurrence early in the pandemic

• Type of Material: Article
• Authors: W. Dana Flanders, Emory University; William Flanders, Emory University; Michael Goodman, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: Elsevier Science Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2020.06.011
• Title of Journal or Parent Work: Annals of Epidemiology
• Volume: 49
• Start Page: 42
• End Page: 49
• Grant/Funding Information: None declared
• Keywords: Life Sciences & Biomedicine; COVID-19; China; Risk factors; Public, Environmental & Occupational Health; Science & Technology; Transmission; SARS-COV-2; Social distancing; Voting
• Research Categories: Health Sciences, Occupational Health and Safety; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Purpose The ongoing coronavirus disease 2019 (COVID-19) severely impacted both health and the economy. Absent an effective vaccine, preventive measures used, some of which are being relaxed, have included school closures, restriction of movement, and banning of large gatherings. Our goal was to estimate the association of voter turnout with county-level COVID-19 risks. Methods We used publicly available data on voter turnout in the March 10 primary in three states, COVID-19 confirmed cases by day and county, and county-level census data. We used zero-inflated negative binomial regression to estimate the association of voter turnout with COVID-19 incidence, adjusted for county-level population density and proportions: over age 65 years, female, Black, with college education, with high school education, poor, obese, and smokers. Results COVID-19 risk was associated with voter turnout, most strongly in Michigan during the week starting 3 days postelection (risk ratio, 1.24; 95% confidence interval, 1.16–1.33). For longer periods, the association was progressively weaker (risk ratio 0.98–1.03). Conclusions Despite increased absentee-ballot voting in the primary, our results suggest an association of voter turnout in at least one state with a detectable increase in risks associated with and perhaps due to greater exposures related to the primary.