Decreases in life expectancy during 2020 were much larger in the United States than in other high income countries, particularly among Hispanic and Black Americans, finds a study published by The BMJ today,
The findings show that between 2018 and 2020, life expectancy in the US decreased by almost two years - 8.5 times the average decrease in 16 other comparable countries - widening the life expectancy gap to 4.69 years.
The gap between life expectancy in the US and other high income countries has been widening for decades. The US had more deaths from covid-19 than any other country, but so far no study has measured the pandemic’s full impact on 2020 life expectancy in the US or the gap with other countries.
To address this, a team of researchers led by Steven Woolf at Virginia Commonwealth University, set out to compare changes in US life expectancy in 2010-18 and during the covid-19 pandemic in 2020 with 16 other high income (peer) nations.
Life expectancy estimates for 2010-2018 were calculated from official life tables and were simulated for 2020. Analysis excluded 2019 because life table data were not available for many peer countries.
The results show that between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years).
Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap substantially to 4.69 years.
Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively.
In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 15 and 18 times the average in peer countries, respectively.
Progress made over the past 20 years in reducing the gap in life expectancy between Black and White populations in the US was erased between 2018 and 2020. Life expectancy in Black men fell to 67.73 years, its lowest level since 1998, and the longstanding Hispanic life expectancy advantage almost disappeared.
These are observational findings and the researchers point to limitations, such as incomplete data on race and ethnicity, and the potential for error due to simulated life expectancies for 2020. However, the study aligns closely with previous research.
The researchers say their findings reflect not only the US’s policy choices and mishandling of the pandemic, but also deeply rooted factors that have put the country at a health disadvantage for decades.
They conclude: “The pandemic will have short and long term effects on the social determinants of health, changing living conditions in many communities, and altering life course trajectories across age groups. Fully understanding the health consequences of these changes poses a daunting but important challenge for future research.”
Even before the pandemic, the US international ranking on life expectancy was poor, despite spending far more on health care than other high income democracies, argues Magali Barbieri at the University of California in a linked editorial.
The pandemic has magnified pre-existing vulnerabilities in US society, she writes.
Understanding the reasons for the disproportionate toll of the disease on the US population and developing appropriate interventions and policies provides an opportunity to correct the structural factors that have historically been hampering US progress in life expectancy and that have been driving large social and ethno-racial inequities in the risks of death.”
Magali Barbieri, University of California
Woolf, S.H., et al. (2021) Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data. BMJ. doi.org/10.1136/bmj.n1343.