County-level association of COVID-19 mortality with 2020 United States presidential voting.

OBJECTIVE: The objective of this study was to assess the association between United States county-level COVID-19 mortality and changes in presidential voting between 2016 and 2020. STUDY DESIGN: The study design is a county-level ecological study. METHODS: We analysed county-level population-weighted differences in partisan vote change, voter turnout and sociodemographic and health status characteristics across pre-election COVID-19 mortality quartiles. We estimated a population-weighted linear regression of the 2020-2016 Democratic vote change testing the significance of differences between quartiles of COVID-19 mortality, controlling for other county characteristics. RESULTS: The overall change in the 2020-2016 Democratic vote was +2.9% but ranged from a +4.3% increase in the lowest mortality quartile counties to +0.9% in the highest mortality quartile counties. Change in turnout ranged from +9.1% in the lowest mortality counties to only +6.2% in highest mortality counties. In regression estimates, the highest mortality quartile was associated with a -1.26% change in the Democratic 2020-2016 vote compared with the lowest quartile (P < 0.001). CONCLUSIONS: Higher county-level COVID-19 mortality was associated with smaller increases in Democratic vote share in 2020 compared with 2016. Possible explanations to be explored in future research could include fear of in-person voting in heavily Democratic, high-mortality counties, fear of the economic effects of perceived Democratic support for tighter lockdowns and stay-at-home orders and general exhaustion that lowered political participation in hard-hit counties.

Contemporary management of men with high-risk localized prostate cancer in the United States.

This corrects the article DOI: 10.1038/pcan.2017.5.

Contemporary management of men with high-risk localized prostate cancer in the United States.

BACKGROUND: Surgery and radiation-based therapies are standard management options for men with clinically localized high-risk prostate cancer (PCa). Contemporary patterns of care are unknown. We hypothesize the use of surgery has steadily increased in more recent years. METHODS: Using the National Cancer Data Base for 2004-2013, all men diagnosed with high-risk localized PCa were identified using National Comprehensive Cancer Network criteria. Temporal trends in initial management were assessed. Multivariable logistic regression was used to evaluate demographic and clinical factors associated with undergoing radical prostatectomy (RP). RESULTS: In total, 127 391 men were identified. Use of RP increased from 26% in 2004 to 42% in 2013 (adjusted risk ratio (RR) 1.51, 95% CI 1.42-1.60, P<0.001), while external beam radiation therapy (EBRT) decreased from 49% to 42% (P<0.001). African American men had lower odds of undergoing RP (unadjusted rate of 28%, adjusted RR 0.69, 95% CI 0.66-0.72, <0.001) compared to White men (37%). Age was inversely associated with likelihood of receiving RP. Having private insurance was significantly associated with the increased use of RP (vs Medicare, adjusted odds ratio 1.04, 95% CI 1.01-1.08, P=0.015). Biopsy Gleason scores 8-10 with and without any primary Gleason 5 pattern were associated with decreased odds of RP (vs Gleason score ⩽6, both P<0.001). Academic and comprehensive cancer centers were more likely to perform RP compared to community hospitals (both P<0.001). CONCLUSION: The likelihood of receiving RP for high-risk PCa dramatically increased from 2004 to 2013. By 2013, the use of RP and EBRT were similar. African American men, elderly men and those without private insurance were less likely to receive RP.