Montez Jennifer Karas, Monnat Shannon M, Wiemers Emily E, Wolf Douglas A, Zhang Xue
Syracuse University, Syracuse, NY, USA.
Cornell University, Ithaca, NY, USA.
J Health Soc Behav. 2024 Sep 13:221465241271072. doi: 10.1177/00221465241271072.
The contextual predictors of mortality in the United States are well documented, but the COVID-19 pandemic may have upended those associations. Informed by the social history of disease framework (SHDF), this study examined how the importance of county contexts on adult deaths from all causes, drug poisonings, and COVID-19-related causes fluctuated during the pandemic. Using 2018 to 2021 vital statistics data, for each quarter, we estimated associations between county-level deaths among adults ages 25 to 64 and prepandemic county-level contexts (economic conditions, racial-ethnic composition, population health profile, and physician supply). The pandemic significantly elevated the importance of county contexts-particularly median household income and counties' preexisting health profile-on all-cause and drug poisoning deaths. The elevated importance of household income may be long-lasting. Contextual inequalities in COVID-19-related deaths rose and then fell, as the SHDF predicts, but rose again along with socio-political disruptions. The findings support and extend the SHDF.
美国死亡率的背景预测因素已有充分记录，但新冠疫情可能颠覆了这些关联。本研究以疾病社会史框架（SHDF）为依据，考察了在疫情期间，县层面的背景因素对各类成人死亡、药物中毒死亡以及新冠相关死亡的重要性是如何波动的。利用2018年至2021年的生命统计数据，我们每季度估算25至64岁成年人的县级死亡人数与疫情前县级背景因素（经济状况、种族构成、人口健康状况和医生供应）之间的关联。疫情显著提升了县背景因素——尤其是家庭收入中位数和各县原有的健康状况——对全因死亡和药物中毒死亡的重要性。家庭收入重要性的提升可能是持久的。正如SHDF所预测的，新冠相关死亡中的背景不平等先上升后下降，但随着社会政治动荡又再次上升。这些发现支持并扩展了SHDF。
