| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 1,002 | 4,036 | 5,118 | |
| 2020 | R | 1,301 | 4,265 | 5,661 | |
| 2016 | R | 1,537 | 3,991 | 5,738 | |
| 2012 | R | 1,562 | 3,318 | 5,008 | |
| 2008 | R | 2,205 | 2,671 | 5,030 | |
| 2004 | D | 3,327 | 2,542 | 5,944 | |
| 2000 | D | 2,902 | 2,084 | 5,073 | |
| 1996 | D | 3,106 | 1,058 | 4,578 | |
| 1992 | D | 3,496 | 1,303 | 5,336 | |
| 1988 | D | 3,387 | 2,149 | 5,580 | |
| 1984 | D | 3,435 | 2,855 | 6,309 | |
| 1980 | D | 3,916 | 1,532 | 5,532 | |
| 1976 | D | 3,544 | 1,014 | 4,576 | |
| 1972 | D | 2,677 | 1,846 | 4,541 | |
| 1968 | D | 2,954 | 1,361 | 4,678 | |
| 1964 | D | 4,714 | 669 | 5,383 | |
| 1960 | D | 3,307 | 1,996 | 5,303 | |
| 1956 | D | 3,246 | 2,423 | 5,673 | |
| 1952 | D | 3,383 | 1,381 | 4,764 | |
| 1948 | D | 3,295 | 957 | 4,264 | |
| 1944 | D | 2,922 | 1,230 | 4,183 | |
| 1940 | D | 3,977 | 1,602 | 5,590 | |
| 1936 | D | 3,980 | 1,790 | 5,781 | |
| 1932 | D | 4,524 | 1,371 | 5,902 | |
| 1928 | D | 3,017 | 2,309 | 5,326 | |
| 1924 | D | 2,826 | 1,708 | 4,544 | |
| 1920 | D | 2,737 | 2,464 | 5,232 | |
| 1916 | D | 2,067 | 1,584 | 3,676 | |
| 1912 | D | 1,682 | 910 | 2,999 | |
| 1908 | R | 1,567 | 1,620 | 3,219 | |
| 1904 | D | 1,537 | 829 | 2,392 | |
| 1900 | D | 1,573 | 850 | 2,434 | |
| 1896 | D | 1,204 | 776 | 1,994 | |
| 1892 | D | 977 | 566 | 1,554 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
Breathitt County, once a reliably Democratic coal-country stronghold in the Cumberland Plateau, has shifted dramatically in presidential voting since 2008, posting margins above R+50 in recent cycles as the regional realignment among working-class voters accelerated.
The unraveling was not abrupt. The Democratic margin in Breathitt County peaked at seventy-five points in 1964; it narrowed steadily over the late twentieth century. The 2008 election delivered the county to the Republican party for the first time in many years, by a margin of nine points. By 2024, the margin had widened further.
The economic and demographic context is severe. Breathitt County's median household income of $34,808 is among the lowest of any county in the United States; 33% of residents live below the federal poverty line. The county's voting pattern over the last decade is most similar to that of Mingo County and Clay County.