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Opioids killed Prince. They may also have something to do with Donald Trump being elected president.

Take it from Penn State demographer Shannon Monnat, who tells Business Insider’s Harrison Jacobs that the counties that went harder for Trump than expected correlated closely with mortality rates stemming from drugs, booze, and suicide. The other two predictors were the portion of white voters and a measure she calls the “economic stress index,” which bundles poverty, unemployment, being uninsured, and other precarious states in a single metric.

“[W]hen you think about the underlying factors that lead to overdose or suicide, it’s depression, despair, distress, and anxiety,” Monnat said, and those are exactly the emotional states that Trump, the master marketer, appealed to. When people in a community are “literally dying,” she notes, it makes sense that they’d vote for massive change, like the many that did in 2008 for Barack Obama. In Ohio, Jacobs reports, almost every county with an overdose mortality rate above 20 per 100,000 people (14.7 is the national average) saw Trump do about 10 percent better than Romney in 2012, or saw Hillary Clinton lose about 10 percent of Obama’s 2012 votes — or both.

Since 2000, America has seen a 137 percent increase in deaths from drug overdoses, with a majority of those deaths involving an opioid, half of those prescription.

It all points to something Arlie Hochschild, a sociologist at University of California, Berkeley, and Strangers in Their Own Land: Anger and Mourning on the American Right, told Science of Us last week. People in these rural communities are the left behind of globalization, automation, and other world-shifting trends. “These are real economic issues that Trump has tried, and perhaps falsely promised, to address,” she said. “The seriousness and reality of that discontent, it doesn’t just reduce to racism.”