According to The Economist it was the sick.
….even after controlling for race, education, age, sex, income, marital status, immigration and employment, these figures remain highly statistically significant. Holding all other factors constant—including the share of non-college whites—the better physical shape a county’s residents are in, the worse Mr Trump did relative to Mr Romney.
For example, in Knox County, Ohio, just north-east of Columbus, Mr Trump’s margin of victory was 14 percentage points greater than Mr Romney’s. One hundred miles (161 km) to the east, in Jefferson County, the Republican vote share climbed by 30 percentage points. The share of non-college whites in Knox is actually slightly higher than in Jefferson, 82% to 79%. But Knox residents are much healthier: they are 8% less likely to have diabetes, 30% less likely to be heavy drinkers and 21% more likely to be physically active. Holding all else equal, our model finds that those differences account for around a six-percentage-point difference in the change in Republican vote share from 2012.
The data suggest that the ill may have been particularly susceptible to Mr Trump’s message. According to our model, if diabetes were just 7% less prevalent in Michigan, Mr Trump would have gained 0.3 fewer percentage points there, enough to swing the state back to the Democrats. Similarly, if an additional 8% of people in Pennsylvania engaged in regular physical activity, and heavy drinking in Wisconsin were 5% lower, Mrs Clinton would be set to enter the White House.
Substantiating this result is the independent work of the incredibly good reporter Sam Quinones, whose “Dreamland” is about opioid addiction in the USA. From a post Quinones put up recently:
Though this scourge has affected every region of the country, it is felt most intensely in rural, suburban – Heartland – areas of America where Donald Trump did extraordinarily well.
Some of these areas did not fully rebound from the Great Recession of 2007 (southern Ohio). Others fared much better (North Carolina). A common denominator, I think political scientists will find, is that in these areas since the last presidential election the incidence of opiate addiction spread, grew deadlier, more public, and went from pain pills to heroin. In southern Ohio, where heroin has hit like pestilence, particularly Appalachia, Trump trounced his opponent in counties that Mitt Romney barely won four years earlier – though unemployment in many of these counties is at its lowest level in years, sometimes decades.
Shannon Monnat, a rural sociologist and demographer at Penn State I talked with, found strong correlations between suicides and fatal drug overdoses in counties where Trump’s increase was larger that the share of the vote compared to Romney’s four years earlier – this in six Rust Belt states, another half-dozen state in New England and all or part of the eight states comprising Appalachia.
“The situation is worse than it has ever been” was a line that struck me from Donald Trump’s acceptance speech at the GOP Convention. To whom would this be more resonant than to those struggling from addiction?
Opiate addiction – to pain pills or heroin — is the closest thing to enslavement that we have in America today. It is brain-changing, relentless, and unmercifully hard to kick. Children who complain at the slightest household chore while sober will, once addicted, march like zombies through the snow for miles, endure any hardship or humiliation, for more dope.
So writes Quinones. Here’s a chart that attempts to quantify this correlation: