| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 1,036 | 4,310 | 5,425 | |
| 2020 | R | 1,333 | 5,148 | 6,527 | |
| 2016 | R | 1,438 | 4,629 | 6,246 | |
| 2012 | R | 2,109 | 3,959 | 6,188 | |
| 2008 | D | 3,430 | 2,882 | 6,430 | |
| 2004 | D | 4,501 | 2,762 | 7,299 | |
| 2000 | D | 4,845 | 2,348 | 7,303 | |
| 1996 | D | 5,989 | 1,550 | 8,208 | |
| 1992 | D | 7,019 | 1,941 | 9,781 | |
| 1988 | D | 7,204 | 2,463 | 9,714 | |
| 1984 | D | 8,546 | 4,284 | 12,883 | |
| 1980 | D | 9,822 | 3,862 | 13,943 | |
| 1976 | D | 10,557 | 4,107 | 14,664 | |
| 1972 | R | 6,811 | 8,942 | 15,753 | |
| 1968 | D | 12,842 | 4,020 | 18,937 | |
| 1964 | D | 18,046 | 3,684 | 21,730 | |
| 1960 | D | 19,501 | 6,555 | 26,056 | |
| 1956 | D | 16,865 | 11,138 | 28,003 | |
| 1952 | D | 24,657 | 10,663 | 35,320 | |
| 1948 | D | 21,545 | 9,687 | 31,472 | |
| 1944 | D | 19,300 | 11,023 | 30,323 | |
| 1940 | D | 24,449 | 13,906 | 38,355 | |
| 1936 | D | 25,471 | 9,975 | 35,481 | |
| 1932 | R | 12,365 | 16,069 | 28,514 | |
| 1928 | R | 8,294 | 14,810 | 23,135 | |
| 1924 | R | 5,561 | 12,422 | 19,732 | |
| 1920 | R | 5,068 | 12,198 | 17,282 | |
| 1916 | R | 3,692 | 7,086 | 10,798 | |
| 1912 | R | 2,497 | 4,341 | 9,327 | |
| 1908 | R | 1,916 | 6,176 | 8,137 | |
| 1904 | R | 1,676 | 5,225 | 6,937 | |
| 1900 | D | 3,761 | 1,218 | 4,990 | |
| 1896 | R | 986 | 2,635 | 3,627 | |
| 1892 | R | 607 | 1,265 | 1,872 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
McDowell's shift from a Democratic bedrock of Appalachian labor politics to an R+60 county tracks the broader collapse of the coal economy and the cultural realignment that followed across southern West Virginia.
The unraveling was not abrupt. The Democratic margin in McDowell County peaked at sixty-six points in 1964; it narrowed steadily over the late twentieth century. The 2012 election delivered the county to the Republican party for the first time in many years, by a margin of thirty points. By 2024, the margin had widened further.
The economic and demographic context is severe. McDowell County's median household income of $31,559 is among the lowest of any county in the United States; 34% of residents live below the federal poverty line. The county's voting pattern over the last decade is most similar to that of Boone County and Floyd County.