Relationship of Political Ideology of US Federal and State Elected Officials and Key COVID Pandemic Outcomes During the Vaccine Era: April 2021-March 2022

Background: Scant research, including in the United States, has quantified relationships between the political ideologies of elected representatives and COVID-19 outcomes among their constituents.Methods: We analyzed observational cross-sectional data on COVID-19 mortality rates (age-standardized) and stress on hospital intensive care unit (ICU) capacity for all 435 US Congressional districts in a period of adult vaccine availability (April 2021-March 2022). Political metrics comprised: (1) ideological scores based on each US Representative’s and Senator’s concurrent overall voting record and their specific COVID-19 votes, and (2) the presence (or not) of state trifectas (Governor, State House, and State Senate have same political party in control). Analyses controlled for Congressional District social metrics, population density, vaccination rates, and voter political lean.Findings: During the US vaccine era, the higher the exposure to conservatism across several political metrics, the higher the COVID-19 age-standardized mortality rates, even after taking into account the Congressional District’s social characteristics; similar patterns occurred for stress on hospital ICU capacity for Republican trifectas and US Senator political ideology scores. For example, in the fully adjusted models, which included the vaccination data, Republican trifecta and conservative voter political lean independently remained significantly associated with a 15% to 25% higher COVID-19 mortality rate.Interpretation: Political ideologies of elected officials and concentrations of political party power are relevant to COVID-19 pandemic dynamics and warrant routine inclusion in population health analyses and monitoring dashboards.Funding Information: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Declaration of Interests: No authors have any competing interests or conflicts of interest to declare.Ethics Approval Statement: This study has been determined to be “not human subjects” research by the Harvard Longwood Campus Institutional Review Board (IRB22-0725, 45 CFR 46.102(e), May 26, 2022).