| Year | Won | Margin | Democratic | Republican | Total |
|---|---|---|---|---|---|
| 2024 | R | 1,561 | 5,203 | 6,811 | |
| 2020 | R | 1,748 | 5,447 | 7,250 | |
| 2016 | R | 1,933 | 5,270 | 7,357 | |
| 2012 | R | 2,814 | 4,284 | 7,250 | |
| 2008 | R | 3,370 | 4,593 | 8,092 | |
| 2004 | R | 3,716 | 4,154 | 7,907 | |
| 2000 | D | 3,738 | 3,416 | 7,266 | |
| 1996 | D | 4,451 | 2,417 | 7,570 | |
| 1992 | D | 4,883 | 2,431 | 8,289 | |
| 1988 | D | 3,812 | 3,387 | 7,208 | |
| 1984 | R | 3,776 | 4,323 | 8,099 | |
| 1980 | D | 4,171 | 4,041 | 8,298 | |
| 1976 | D | 5,319 | 2,798 | 8,136 | |
| 1972 | R | 3,500 | 4,735 | 8,235 | |
| 1968 | D | 4,195 | 2,317 | 9,496 | |
| 1964 | D | 7,415 | 2,583 | 9,998 | |
| 1960 | D | 7,373 | 4,205 | 11,578 | |
| 1956 | D | 8,419 | 3,552 | 11,971 | |
| 1952 | D | 8,504 | 3,809 | 12,329 | |
| 1948 | D | 8,925 | 2,082 | 11,018 | |
| 1944 | D | 7,626 | 4,108 | 11,752 | |
| 1940 | D | 9,591 | 6,318 | 15,933 | |
| 1936 | D | 7,791 | 5,056 | 12,872 | |
| 1932 | D | 7,837 | 3,768 | 11,652 | |
| 1928 | R | 4,153 | 4,750 | 8,925 | |
| 1924 | D | 4,167 | 4,018 | 8,312 | |
| 1920 | R | 3,637 | 3,745 | 7,498 | |
| 1916 | D | 2,715 | 2,039 | 4,879 | |
| 1912 | D | 1,945 | 1,607 | 4,519 | |
| 1908 | D | 1,824 | 1,436 | 3,375 | |
| 1904 | D | 1,257 | 922 | 2,196 | |
| 1900 | D | 1,379 | 668 | 2,052 | |
| 1896 | D | 1,639 | 480 | 2,121 | |
| 1892 | D | 1,215 | 361 | 1,647 | |
| 1888 | — | — | — | — | |
| 1884 | — | — | — | — | |
| 1880 | — | — | — | — | |
| 1876 | — | — | — | — |
New Madrid County, anchored by the Missouri Bootheel's agricultural flatlands, has shifted from a competitive rural Democrat stronghold to one of the state's most one-sided presidential counties over the past two decades, reflecting a broader realignment across the rural Midwest.
The unraveling was not abrupt. The Democratic margin in New Madrid County peaked at sixty-two points in 1948; it narrowed steadily over the late twentieth century. The 2004 election delivered the county to the Republican party for the first time in many years, by a margin of six points. By 2024, the margin had widened further.
The economic and demographic context is severe. New Madrid County's median household income of $51,881 is among the lowest of any county in the United States; 18% of residents live below the federal poverty line. The county's voting pattern over the last decade is most similar to that of Mississippi County and Randolph County.