| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 2,473 | 4,357 | 6,907 | |
| 2020 | R | 2,491 | 4,196 | 6,785 | |
| 2016 | R | 2,108 | 3,670 | 6,017 | |
| 2012 | R | 2,370 | 3,619 | 6,080 | |
| 2008 | R | 2,391 | 3,545 | 6,006 | |
| 2004 | R | 1,914 | 3,336 | 5,377 | |
| 2000 | R | 1,671 | 2,844 | 4,689 | |
| 1996 | R | 1,704 | 2,141 | 4,297 | |
| 1992 | R | 1,597 | 2,224 | 4,685 | |
| 1988 | R | 1,361 | 2,571 | 4,018 | |
| 1984 | R | 1,206 | 2,612 | 3,885 | |
| 1980 | R | 1,395 | 1,810 | 3,344 | |
| 1976 | R | 1,312 | 1,608 | 3,039 | |
| 1972 | R | 730 | 2,164 | 2,987 | |
| 1968 | R | 575 | 809 | 2,042 | |
| 1964 | R | 3,238 | 4,976 | 8,227 | |
| 1960 | R | 574 | 823 | 1,402 | |
| 1956 | R | 338 | 721 | 1,243 | |
| 1952 | R | 507 | 705 | 1,221 | |
| 1948 | D | 457 | 271 | 879 | |
| 1944 | D | 627 | 186 | 816 | |
| 1940 | D | 586 | 125 | 713 | |
| 1936 | D | 653 | 123 | 781 | |
| 1932 | D | 595 | 127 | 742 | |
| 1928 | D | 397 | 318 | 715 | |
| 1924 | D | 438 | 78 | 523 | |
| 1920 | D | 438 | 170 | 609 | |
| 1916 | D | 373 | 155 | 528 | |
| 1912 | D | 374 | 128 | 524 | |
| 1908 | D | 413 | 164 | 577 | |
| 1904 | D | 416 | 151 | 571 | |
| 1900 | D | 686 | 640 | 1,330 | |
| 1896 | D | 688 | 680 | 1,376 | |
| 1892 | R | 271 | 291 | 604 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
Middlesex County hugs the Rappahannock River where it meets the bay, and its small, predominantly white, aging population has delivered Republican presidential margins above 25 points in each of the last three cycles.
The Democratic margin in Middlesex County peaked at sixty-nine points in 1924. By 1952 the county had flipped, voting Republican for the first time in many years. The 2024 margin was twenty-seven points, the most Republican-leaning result in the county's modern history.
The economic context is the key. Middlesex County's median household income of $75,060 sits well below state and national norms, and 7% 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 Gloucester County and Mathews County.