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.

中文翻译：

---

美国工作年龄死亡率的背景预测因子的稳定性和波动性


美国死亡率的背景预测指标有据可查，但 COVID-19 大流行可能已经颠覆了这些关联。以疾病社会史框架 （SHDF） 为信息，本研究考察了县级环境对成人因各种原因死亡、药物中毒和 COVID-19 相关原因的重要性在大流行期间是如何波动的。使用 2018 年至 2021 年的生命统计数据，对于每个季度，我们估计了 25 至 64 岁成年人的县级死亡人数与大流行前县级环境（经济状况、种族-民族构成、人口健康状况和医生供应）之间的关联。大流行显着提高了县环境（尤其是家庭收入中位数和县先前存在的健康状况）对全因和药物中毒死亡的重要性。家庭收入的重要性提升可能是长期的。正如 SHDF 预测的那样，与 COVID-19 相关的死亡人数的背景不平等先上升后下降，但随着社会政治动荡而再次上升。调查结果支持并扩展了 SHDF。