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U.S. life expectancy decreased by an 'alarming' amount during pandemic

Health in the U.S. has been lagging behind comparable countries for decades.
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Average life expectancy in the United States plummeted in 2020, widening the life expectancy gap between the U.S. and other high-income countries. The decline was particularly sharp among Hispanic and Black Americans, a new study found.

Health experts anticipated life expectancy would drop during the pandemic, but how much it did came as a surprise.

“I naively thought the pandemic would not make a big difference in the gap because my thinking was that it’s a global pandemic, so every country is going to take a hit,” said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, who led the new study. “What I didn’t anticipate was how badly the U.S. would handle the pandemic.”

The new study used data from the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, and the Human Mortality Database to measure changes in life expectancy between 2018 and 2020 among Black, white and Hispanic Americans. The available data did not allow the researchers to include Asian, Pacific Islander, American Indian and Alaska Native populations in the comparison. The results were published Wednesday in The BMJ.

Between 2018 and 2020, the decrease in average life expectancy at birth in the U.S. was roughly 1.9 years — 8.5 times the average decrease in 16 comparable countries, which was about 2.5 months. The decrease widened the gap between the U.S. and its peers to nearly 5 years, but the difference is much larger among Black and Hispanic Americans.

What the enormous drop in life expectancy tells us is not how long a baby born in 2020 will live but instead how high the death rate for the entire population was during 2020.

Compared with white Americans, whose average life expectancy at birth dropped by about 1.4 years between 2018 and 2020, the average Hispanic American’s decreased by just under 3.9 years. The average lifespan of a Black American decreased by 3.25 years.

“These are numbers we aren’t at all used to seeing in this research; 0.1 years is something that normally gets attention in the field, so 3.9 years and 3.25 years and even 1.4 years is just horrible,” Woolf said. “We haven’t had a decrease of that magnitude since World War II.”

Following WWII, life expectancy in the U.S. was climbing for decades. But in the 1990s, the pace of longevity started to slow. Americans went from having a higher life expectancy compared to comparable nations to falling below average. The trend continued until around 2010, when the average age of death in the U.S. plateaued, and then entered a three-year decline in 2014.

“The gap between the U.S. and other countries was really widening at that point,” Woolf said.

But in 2019, just prior to the pandemic, life expectancy at birth in the U.S. increased by 0.1 years — about 1.5 months.

“The real worry is that we were essentially making no progress compared to other countries,” Woolf said.

Ripple effect

Health officials calculate life expectancy at birth to better understand a country’s health over time. Estimates of life expectancy during the Covid-19 pandemic don’t predict how long a group of people will live but rather illustrate who was most affected.

“What the enormous drop in life expectancy tells us is not how long a baby born in 2020 will live but instead how high the death rate for the entire population was during 2020,” Woolf said.

Although life expectancy is expected to increase in 2021, the pandemic will have lasting financial, mental and physical health consequences that will ripple far beyond 2020. Especially last spring, people were delaying screenings or emergency care out of fear of being exposed to Covid-19. For others, medical care was delayed. These consequences have the power to shorten Americans’ lifespans in the coming decades, Woolf and his colleagues noted.

"The ripple effects of the pandemic will affect babies born in this year not only because of the immediate effects on their gestation and infancy in the height of the pandemic but because the economic and social upheaval that the pandemic is leaving in its wake will influence child development and health trajectories," Woolf said. "This isn’t to say that the lifespan of a child born last year will be shortened to these predictions, but on average, we can expect that today’s children will be affected by this experience."

A system of poor health

According to Paula Braveman, director of the Center for Health Equity at the University of California, San Francisco, a stark racial divide exists in American health outcomes, but poor health is a national issue.

"When you compare the U.S. to other affluent countries, the issue is not contained to poor health outcomes among people of color," said Braveman, who was a co-author with Woolf on a 2013 National Institutes of Health report that analyzed which factors were at fault for America’s poor health performance. "The U.S. health advantage is seen across the race and class spectrum."

Everyday stressors in American life tend to eclipse those of other countries, contributing to chronic disease and mortality, Braveman said.

“Things like affording child care are a major source of stress for people even in the middle class, and lack of good public transportation means people are sometimes commuting hours to work," Braveman said.

Social determinants of health rooted in inequity — including poverty, where a person lives, to which types of food they have access and their education — were also hugely important factors in a person’s health, especially among nonwhite Americans.

“Those tendencies in the U.S. that we outlined in 2013 were on full display during the pandemic, and the systemic issues that cause them are still in place,” Woolf said.

Closing the racial gap

The U.S. has made progress over the past two decades in shrinking the gap in life expectancy between Black and white Americans. But the new study found that those gains were effectively erased during the pandemic.

Life expectancy for Black men living in the U.S. fell to just under 68 years, its lowest level since 1998. As of 2020, Hispanic men have the second-lowest life expectancy at birth, at 74.5 years, which closely follows the 74.7 years for white men. Black women have a life expectancy at birth of 75.3 years, which is lower than white women at 80 years and Hispanic women at 81.4 years.

Historically, life expectancy for Hispanic Americans has been a couple years higher than white Americans, but the gap nearly closed in 2020. This means the reductions in life expectancy among Hispanic Americans and Black Americans are 18 and 15 times lower than peer country averages.

Woolf anticipated that because Covid-19 mortality was higher in Black and Latinx populations, these communities would see a larger decrease compared to white Americans.

“But the scale of the difference was horrific,” he said.

Melissa Creary, assistant professor of health management and policy at the University of Michigan School of Public Health, worries that Black Americans in particular will continue to be disproportionately affected by the pandemic in the long term.

Black Americans are already more likely than white Americans to face barriers created by social determinants of health. They are more likely to rent their homes, have lower education, make less money, live in polluted neighborhoods and not hold employer-sponsored health insurance.

“We still have to pay attention to the social determinants of health that were occurring before the pandemic, which made Black and brown communities at a higher risk of dying of the coronavirus. The root causes of co-morbidities aren’t biological; they’re social,” said Creary, who was not associated with the new research.

Black Americans are also turning down Covid-19 vaccines at higher rates than other races, something Creary worries isn’t being taken into account as the nation begins to open back up.

“Vaccine hesitancy underpinned by racism and mistrust in the health care system hasn’t gone away even though these other protective factors like mask mandates have,” she said.

To make lasting changes and to close the racial gap in health outcomes, Creary said the nation needs to invest in long-term trust, and that starts with anti-racist medical training for physicians.

"If I have a disease that a doctor doesn’t understand, my life is threatened," she said. "If I am a Black or brown person and you don’t have anti-racist training, my life is threatened in the same way."

CORRECTION (June 24, 10:50 a.m.): An earlier version of this article transposed the life expectancy declines for Hispanic Americans and Black Americans. The reduction in life expectancy among Hispanic Americans is 18 times lower than peer country averages, not 15 times; and for Black Americans, it is 15 times lower than peer country averages, not 18 times.