DeBie Kelly A, Gutilla Margaret J, Keller Kayleigh P, Peel Jennifer L, Rojas-Rueda David, Neophytou Andreas M
Author Affiliations: Department of Environmental and Radiological Health Sciences (Drs DeBie, Peel, Rojas-Rueda, and Neophytou), Colorado School of Public Health (Drs Gutilla, Keller, Peel, Rojas-Rueda, and Neophytou), Department of Health and Exercise Science (Dr Gutilla), and Department of Statistics (Dr Keller), Colorado State University, Fort Collins, Colorado.
Department of Health and Exercise Science (Dr Gutilla), and Department of Statistics & Colorado School of Public Health (Dr Keller), Colorado State University, Fort Collins, Colorado.
J Public Health Manag Pract. 2025;31(3):E179-E186. doi: 10.1097/PHH.0000000000002098. Epub 2024 Dec 26.
The Coronavirus disease 2019 (COVID-19) pandemic occurred during a time of political tension in the United States. County-level political environment may have been influential in COVID-19 outcomes.
This study examined the association between county-level political environment and age-adjusted COVID-19 mortality rates from 2020 to 2022.
Political environment was measured by the 2020 Presidential election results and compared with age-adjusted COVID-19 mortality rates by county in Colorado.
Rate ratios (RR) and 95% confidence intervals (CI) were estimated using negative binomial regression incorporating a population offset term. Models adjusted for populational differences using the demographics percentile from Colorado's EnviroScreen Environmental Justice Tool.
Age-adjusted county mortality rates ranged from 14.3 to 446.8.0 per 100 000. 2021 COVID-19 mortality rates were nearly twice as high in counties voting for Donald Trump compared to those voting for Joseph Biden (adjusted RR = 1.98, 95% CI: 1.59, 2.47). Results for 2020 and 2022 mortality models were also in the positive direction, though the confidence intervals crossed null values.
These results build on a growing body of evidence that political environment may have been influential for COVID-19 mortality, helping to understand the drivers of health outcomes. Implications for the public health system as we shift into the endemic period of COVID-19 include motivation for collaborative work to restore and rebuild trust among and between stakeholders and the community, as well as increase health education given its' influence on both individual and community behaviors.
2019年冠状病毒病（COVID-19）大流行发生在美国政治紧张时期。县级政治环境可能对COVID-19的结果产生影响。
本研究调查了2020年至2022年县级政治环境与年龄调整后的COVID-19死亡率之间的关联。
政治环境通过2020年总统选举结果来衡量，并与科罗拉多州各县年龄调整后的COVID-19死亡率进行比较。
使用纳入人口偏移项的负二项回归估计率比（RR）和95%置信区间（CI）。模型使用科罗拉多州环境筛查环境正义工具中的人口统计学百分位数对人口差异进行了调整。
年龄调整后的县死亡率为每10万人14.3至446.8。2021年，投票给唐纳德·特朗普的县的COVID-19死亡率几乎是投票给约瑟夫·拜登的县的两倍（调整后的RR = 1.98，95% CI：1.59，2.47）。2020年和2022年死亡率模型的结果也呈正向，尽管置信区间跨越了零值。
这些结果建立在越来越多的证据基础上，即政治环境可能对COVID-19死亡率产生影响，有助于理解健康结果的驱动因素。随着我们进入COVID-19的流行期，对公共卫生系统的影响包括推动开展合作工作，以恢复和重建利益相关者与社区之间的信任，以及鉴于其对个人和社区行为的影响而加强健康教育。
