U.S. life expectancy may drop for the second year, minorities most affected

As 2021 draws to its close, the coronavirus disease 2019 (COVID-19) pandemic continues to threaten human health. As thousands of infections continue to be reported, the impact of the outbreak is evident in the estimated reduction of life expectancy at birth for the second successive year. Unfortunately, the impact is higher for the Black and Latino populations as compared to Whites.

Study: Reductions in US life Expectancy From COVID-19 By Race and Ethnicity: Is 2021 A Repetition Of 2020? Image Credit: Hyejin Kang / Shutterstock.com

Background

In 2020, over 350,000 deaths in the United States were attributed to COVID-19. This staggering death toll has been held responsible for approximately 75% of the reduction in life expectancy at birth by 1.5 years, a direct reversal of the upward trend observed over the last 16 years.

The emergency approval of two vaccines built on the messenger ribonucleic acid (mRNA) technology was followed by their mass distribution across the country. COVID-19 vaccine rollout was expected to rapidly reduce mortality due to COVID-19 and subsequently limit the worsening of COVID-19’s impact on life expectancy in 2021.

Even though the vaccines were not likely to restore life expectancy at birth to previous levels before the pandemic began, a significant improvement was expected. However, vaccine coverage has not reached expected levels in the U.S., and the degree of immunity achieved is inadequate to arrest the transmission of the Delta variant of the SARS-CoV-2.

As a result, the U.S. has continued to experience more than 2,000 deaths per day before the fall began, with the total number of deaths by October 15, 2021, matching over 90% of the total deaths in 2020. A disturbing aspect of these deaths was that the average age shifted downwards during 2021, partly because a larger proportion of older individuals had been protected by vaccination.

These two factors must be considered to understand how COVID-19 affects life expectancy in 2021.

Secondly, the pandemic affected Latinos and Blacks in America much more severely than Whites. The decline in life expectancy in these vulnerable groups was twice as large as for Whites due to a mix of interwoven factors. This includes crowded housing, large families living together, as well as frontline jobs entailing high levels of exposure with lower priority for personal protective equipment and vaccination.

These populations are also more likely to use public transport, experience poverty due to low-paying jobs, poor access to healthcare, and exhibit increased rates of comorbid conditions such as hypertension, diabetes, obesity, and cardiovascular disease. As a result, these population groups remain highly susceptible to severe COVID-19 and fatal outcomes.

Simultaneously, there were difficulties in the path of vaccination of these groups, including the lack of skills and/or facilities needed to book vaccine appointments online, lack of transport facilities to vaccination sites, and the inability to take leave from the workplace or job in order to get the vaccine and recover from any side effects.

The fact remains that far more Whites were vaccinated than other ethnic groups in the initial phase of the pandemic. In addition, the already lower life expectancy of below 72 years among these groups led to the virtual exclusion of the elderly from the initial priority-based vaccination efforts that targeted the above-75 age group.

Notably, these inequalities are improving as a result of the increased availability of vaccines. However, partisan political views, religious stances, and rural/urban location exert greater influence on vaccination rates than racial-ethnic factors.

It is now almost certain that life expectancy estimates for 2021 will continue to reflect a huge toll experienced by all groups.”

In the current study, which is available as a preprint on the medRxiv* server, the scientists estimate the effect of the pandemic on life expectancy at birth, at 65 years overall, as well as for individual populations. These estimates are based on the projections of COVID-19 mortality provided by the Institute of Health Metrics and Evaluation (IHME) for the rest of the year.

Study findings

The authors found that COVID-19 deaths up to October 2021 had exceeded the number that would lead to a reduction in life expectancy at birth by 1.2 years, and at age 65 by 0.8 years. The greatest decline was at 2.4 years for the Latinos, 1.5 years for Blacks, and 1 year for Whites.

Even for the Whites, this is 0.1 years more than the 0.9 years of reduced life expectancy that was reported after the course of the pandemic over the whole of 2020. For Blacks and Latinos, there is a further reduction by 0.4-0.5 years as compared to the 2020 decline.

In terms of the projected reduction in life expectancy at the end of 2021, the researchers used IHME statistics to estimate a reduction in life expectancy at birth of 1.8 years. This is in excess of the 1.3-year drop experienced last year. At age 65, the overall drop will be 1.1 years, which is equal to the estimates for 2020.

Disturbingly, life expectancy estimates at birth in 2021 show a larger decline across all three ethnic groups than for 2020. The greatest drop is seen with Whites, who lost another 0.4 years. For Latinos and Blacks, life expectancy is reduced by 3.1 years and 2.1 years, respectively. This reduction is 2.4 and 1.6 times that experienced by the Whites, respectively.

These disparities reveal another year of especially large racial/ethnic inequities underlying a large overall impact of COVID-19 on life expectancy.”

Implications

The findings of this study indicate that the impact of COVID-19 on life expectancy at birth and at age 65 will be as destructive, if not more, in 2021 as in 2020. Since these estimates did not include deaths from non-COVID-19 causes such as inadvertent trauma, disease, and murders, the actual figures may be even greater.

The presence of marked disparities between racial/ethnic groups with respect to the COVID-19 pandemic’s impact is evident. The narrowing of the gap in life expectancy between the population groups is due to the further lowering of this measure among Whites, rather than as a result of a decline in the reduction rate among the other groups.

Since Blacks have a disproportionate number of deaths from other causes, the ultimate reduction in life expectancy in 2021 will inevitably exceed the aforementioned estimate as well. Delays in receiving, processing, and reporting COVID-19 deaths will further lower the projected figures.

There is still much uncertainty regarding COVID-19 mortality in the final months of 2021, which will depend on further vaccine uptake, waning vaccine efficacy, and whether the US experiences another winter surge in cases, among other factors.”

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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Comments

  1. Mr Gruust Mr Gruust Germany says:

    The discussion about COVID-19 vaccinations is spread thin by throwing around all sorts of facts. Can't we concentrate on one primary number expressing the overall effect of vaccination? Like expected effect on life expectancy as a measure for net effect of vaccination side-effects and COVID-19 effects? Or a ratio of severe side effects and prevented severe COVID-19 cases? Wouldn't that be a clearer measure? Or are the reported (and I guess unverified) side-effects of vaccination too high such that all experts know that such a number would look awful?

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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