| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 190 | 904 | 1,105 | |
| 2020 | R | 215 | 877 | 1,107 | |
| 2016 | R | 195 | 808 | 1,046 | |
| 2012 | R | 341 | 664 | 1,048 | |
| 2008 | R | 427 | 707 | 1,174 | |
| 2004 | R | 436 | 691 | 1,132 | |
| 2000 | R | 469 | 651 | 1,158 | |
| 1996 | D | 572 | 540 | 1,273 | |
| 1992 | D | 599 | 483 | 1,413 | |
| 1988 | D | 732 | 677 | 1,411 | |
| 1984 | R | 734 | 921 | 1,655 | |
| 1980 | R | 760 | 833 | 1,657 | |
| 1976 | D | 969 | 771 | 1,749 | |
| 1972 | R | 727 | 1,170 | 1,897 | |
| 1968 | R | 853 | 924 | 1,903 | |
| 1964 | D | 1,373 | 831 | 2,204 | |
| 1960 | R | 1,323 | 1,355 | 2,678 | |
| 1956 | D | 1,354 | 1,338 | 2,692 | |
| 1952 | R | 1,227 | 1,682 | 2,914 | |
| 1948 | D | 1,563 | 1,162 | 2,732 | |
| 1944 | R | 1,437 | 1,444 | 2,881 | |
| 1940 | R | 1,702 | 1,807 | 3,513 | |
| 1936 | D | 1,944 | 1,581 | 3,556 | |
| 1932 | D | 1,763 | 1,041 | 2,821 | |
| 1928 | R | 1,407 | 1,839 | 3,257 | |
| 1924 | R | 1,650 | 1,666 | 3,355 | |
| 1920 | R | 1,532 | 1,888 | 3,450 | |
| 1916 | D | 1,079 | 892 | 2,014 | |
| 1912 | D | 973 | 769 | 1,966 | |
| 1908 | D | 993 | 985 | 2,034 | |
| 1904 | R | 967 | 1,042 | 2,093 | |
| 1900 | D | 1,123 | 1,023 | 2,237 | |
| 1896 | D | 1,248 | 885 | 2,146 | |
| 1892 | D | 696 | 624 | 1,865 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
Worth County's 2024 presidential margin of R+64.6 reflects a pattern common to Missouri's sparsely settled northwest corner, where small, aging rural populations have shifted sharply toward Republican candidates over the past two decades.
The Democratic margin in Worth County peaked at twenty-six points in 1932. By 2000 the county had flipped, voting Republican for the first time in many years. The 2024 margin was sixty-five points, the most Republican-leaning result in the county's modern history.
The economic context is the key. Worth County's median household income of $47,847 sits well below state and national norms, and 21% of residents live below the federal poverty line. The shift here is part of a broader realignment of working-class places across the country. The county's voting pattern over the last decade is most similar to that of Daviess County and Gentry County.