A big reason President Trump prevailed in 2016 was his massive margins in what are called the “Middle Suburbs,” largely blue-collar counties heavily concentrated in the industrial Midwest. Trump won those areas by 13 points — a key reason he flipped Wisconsin, Michigan and Pennsylvania.

A new report helps explain why this happened — but it also points to why he may struggle to duplicate this performance, which could badly complicate his reelection hopes.

The report finds that “Deaths of Despair” were far higher than the national average in these Middle Suburban counties over the five-year period from 2014 to 2018.

Deaths of Despair are deaths from alcohol, drugs and suicide, which are thought to be partly rooted in a social cause, such as the collapse of working-class life prospects and/or community life.

The report is from the American Communities Project, a group that divides U.S. counties into 15 types. The “Middle Suburbs” refer to places that are 85 percent white, both less diverse and less affluent than either the “Urban Suburbs” (which are more densely populated and more cosmopolitan) or “Exurbs” (which are further out and much more Republican).

Trump’s big Middle Suburb margins were a surprise, because they are generally swing territory that Barack Obama won in 2008 and narrowly lost in 2012.

The new report finds that over that 2014-2018 period, the Middle Suburbs suffered an average annual rate of 56.3 Deaths of Despair per 100,000 residents. That’s far higher than the Urban Suburbs (39.3 deaths per 100,00) or the Exurbs (40.2 deaths) or the Big Cities (38.0 deaths).

So Deaths of Despair did soar in regions where Trump won big. But that hasn’t abated through 2018, complicating Trump’s reelection case. With the coronavirus, that is surely getting worse.

The report also scrambles numerous assumptions. Deaths of Despair are not confined to working-class whites; many African American communities suffer from them, though at lower rates. And the familiar rural-vs.-cosmopolitan political geography is blurred, as Middle Suburbs are the site of great suffering.

I spoke to Dante Chinni, the director of the American Communities Project, about the new report and its relevance to 2020. An edited and condensed transcript follows.

Greg Sargent: Can you tell us what a Middle Suburb is?

Dante Chinni: The Middle Suburbs are counties largely in the Great Lakes region and the industrial Midwest, heavily based in Pennsylvania, Michigan, Ohio, Wisconsin. The median household income is close to average.

They’re not as well-educated as the country as a whole. They’re whiter than the country as a whole. They’re blue-collar communities that have a strong industrial base. They’ve seen a lot of that disappear.

Sargent: What really distinguishes a Middle Suburb from an Exurb or an Urban Suburb?

Chinni: The Exurbs are also very white. But they are better educated with higher incomes. The Urban Suburbs are a little closer into cities. They are much more diverse, but they’re also higher income.

The Middle Suburbs are kind of the suburbs the way we used to think of them. A lot are white flight suburbs. They used to do well when there were good jobs for people who didn’t have college degrees. You see them bunched up around Cleveland, Detroit, Pittsburgh. These are places that missed out on the good times economically.

Sargent: What made them so hospitable to Trump?

Chinni: He was promising to bring back something that wasn’t there anymore. Nobody can really do it. It’s not just about jobs going overseas. It’s about jobs lost to automation, and also the decline of unions.

These places are not what they used to be. Trump was promising to bring that life back to them.

Sargent: What happened in these places in the 2018 elections?

Chinni: A lot of those Trump margins went away. Macomb County in Michigan voted Democratic. You saw something similar in the Middle Suburbs in Ohio and Pennsylvania. The hope that Republicans have is that’s all because Trump wasn’t on the ballot.

Sargent: If in your report things are so bad as of 2018, we’ve got to assume they’re even worse under covid-19. Isn’t the groundwork laid for a real calamity in some of those places?

Chinni: I think it is. Covid really does ramp up what these places are experiencing.

Sargent: Is there really a chance that Trump wins them by anything close to 13 points again?

Chinni: It’s hard to imagine. In 2016, he was new. He was promising something. Now you’re four years in. I grew up in one of these places. The one thing they’re not is patient. They’ve been burned by elites for 20 to 30 years.

Sargent: We talk constantly about the suburban shift. The archetype is usually a college-educated white, likely a woman, maybe a knowledge worker plugged into the global or digital economy. These are people alienated by Trump’s racial incitement and denial of covid. The Middle Suburbs aren’t quite those same people, are they?

Chinni: They aren’t at all. These Middle Suburbs will slowly shift more Republican. They’ve very different.

In Michigan, Oakland County is an Urban Suburb and Macomb is a Middle Suburb. They have flipped places over the last 20 years. It used to be that they were both battlegrounds but Macomb would go Democratic before Oakland would. Now Oakland is solidly Democratic and Macomb is Republican.

The suburbanites you’re talking about — these wealthy, educated knowledge workers — are much more heavily concentrated in those Urban Suburbs.

Sargent: If Trump is already losing those Urban Suburban types by large margins, and he’s also struggling among these Middle Suburban people who aren’t even in that basket, that seems like double trouble for him.

Chinni: He needs these people. It’s going to be a tough place to make a compelling argument that things are appreciably better than they were four years ago.

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