[Sloppy]

Maybe true but is it causal?

Said another way, maybe counties with poor medical facilities, poorer people, etc. are more attracted to voting Republican. The title might read "The downtrodden are more attracted to Republican ideas"

Not saying this is true either it's just that the causal factors may not be part of the study. They tried to include race/color and gender but the effect is still visible across the board.

They did not study obesity or income level, which I suspect would show even stronger correlation to an increase in AAMR than what the county voted in the last election.