The relationship between voting restrictions and COVID-19 case and mortality rates between US counties

Roman Pabayo; Erin Grinshteyn; Brian Steele; Daniel M Cook; Peter Muennig; Sze Yan Liu

doi:10.1371/journal.pone.0267738

The relationship between voting restrictions and COVID-19 case and mortality rates between US counties

PLoS One. 2022 Jun 1;17(6):e0267738. doi: 10.1371/journal.pone.0267738. eCollection 2022.

Authors

Roman Pabayo¹, Erin Grinshteyn², Brian Steele¹, Daniel M Cook³, Peter Muennig⁴, Sze Yan Liu⁵

Affiliations

¹ University of Alberta School of Public Health, Edmonton, Alberta, Canada.
² Health Professions Department, University of San Francisco, San Francisco, California, United States of America.
³ School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America.
⁴ Columbia Mailman School of Public Health, New York City, New York, United States of America.
⁵ Public Health Department, Montclair State University, Montclair, New Jersey, United States of America.

Abstract

Background: Since the 2010 election, the number of laws in the U.S. that create barriers to voting has increased dramatically. These laws may have spillover effects on population health by creating a disconnect between voter preferences and political representation, thereby limiting protective public health policies and funding. We examine whether voting restrictions are associated with county-level COVID-19 case and mortality rates.

Methods: To obtain information on restricted access to voting, we used the Cost of Voting Index (COVI), a state-level measure of barriers to voting during a U.S. election from 1996 to 2016. COVID-19 case and mortality rates were obtained from the New York Times' GitHub database (a compilation from multiple academic sources). Multilevel modeling was used to determine whether restrictive voting laws were associated with county-level COVID-19 case and mortality rates after controlling for county-level characteristics from the County Health Rankings. We tested whether associations were heterogeneous across racial and socioeconomic groups.

Results: A significant association was observed between increasing voting restrictions and COVID-19 case (ß = 580.5, 95% CI = 3.9, 1157.2) and mortality rates (ß = 16.5, 95% CI = 0.33,32.6) when confounders were included.

Conclusions: Restrictive voting laws were associated with higher COVID-19 case and mortality rates.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Humans
New York
Politics

Grants and funding

This study was supported by the Canada Research Chair program, of which RP is a recipient of. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.