ArticlePloS one2017
County community health associations of net voting shift in the 2016 U.S. presidential election.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed.
- The role of health and health systems in shaping political engagement and rebuilding trust in democratic institutions.The Lancet regional health. Europe · 2025Review
- The health costs of losing political representation: Evidence from U.S. Presidential Elections.PloS one · 2025Article
- Article
- Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level.JMIR public health and surveillance · 2021Article
- Article
- Health and voting over the course of adulthood: Evidence from two British birth cohorts.SSM - population health · 2020Article
- A Population Health Perspective on the Trump Administration, Brexit, and Right-Wing Populism in Europe.American journal of public health · 2020Article
- Deaths of Despair and Brexit Votes: Cross-Local Authority Statistical Analysis in England and Wales.American journal of public health · 2020Article
- Independent Relationship of Changes in Death Rates with Changes in US Presidential Voting.Journal of general internal medicine · 2019Article
- Association of Chronic Opioid Use With Presidential Voting Patterns in US Counties in 2016.JAMA network open · 2018Article
- Population well-being and electoral shifts.PloS one · 2018Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
importanceIn the U.S. presidential election of 2016, substantial shift in voting patterns occurred relative to previous elections. Although this shift has been associated with both education and race, the extent to which this shift was related to public health status is unclear.
objectiveTo determine the extent to which county community health was associated with changes in voting between the presidential elections of 2016 and 2012.
designEcological study with principal component analysis (PCA) using principal axis method to extract the components, then generalized linear regression.
settingGeneral community.
participantsAll counties in the United States. EXPOSURES: Physically unhealthy days, mentally unhealthy days, percent food insecure, teen birth rate, primary care physician visit rate, age-adjusted mortality rate, violent crime rate, average health care costs, percent diabetic, and percent overweight or obese. MAIN OUTCOME: The percentage of Donald Trump votes in 2016 minus percentage of Mitt Romney votes in 2012 ("net voting shift").
resultsComplete public health data was available for 3,009 counties which were included in the analysis. The mean net voting shift was 5.4% (+/- 5.8%). Of these 3,009 counties, 2,641 (87.8%) had positive net voting shift (shifted towards Trump) and 368 counties (12.2%) had negative net voting shift (shifted away from Trump). The first principal component ("unhealthy score") accounted for 68% of the total variance in the data. The unhealthy score included all health variables except primary care physician rate, violent crime rate, and health care costs. The mean unhealthy score for counties was 0.39 (SD 0.16). Higher normalized unhealthy score was associated with positive net voting shift (22.1% shift per unit unhealthy, p < 0.0001). This association was stronger in states that switched Electoral College votes from 2012 to 2016 than in other states (5.9% per unit unhealthy, p <0.0001). CONCLUSIONS AND RELEVANCE: Substantial association exists between a shift toward voting for Donald Trump in 2016 relative to Mitt Romney in 2012 and measures of poor public health. Although these results do not demonstrate causality, these results suggest a possible role for health status in political choices.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.