Life expectancy in the United States, which declined dramatically in 2020 as the coronavirus slammed into the country, continued to go down in 2021, according to a new analysis that shows the United States faring worse during the pandemic than 19 other wealthy countries — and failing to see a life expectancy rebound despite the arrival of effective vaccines.
The study, written by public health experts in Colorado, Virginia and D.C. and posted online but not yet peer-reviewed, found that the continued decline in life expectancy in 2021 came largely among White Americans.
That was a reversal of the trend from 2020. Then, the dramatic decline in life expectancy among all Americans was far more pronounced in Hispanic and Black Americans than in Whites, a reflection of the disproportionate impact of the virus on communities of color and chronic health disparities. But the 2021 data turned that trend on its head.
The authors of the report speculate that vaccine hesitancy and the much-documented resistance to pandemic restrictions among some White Americans and in states with disproportionately White populations could be a factor in that reversal of the 2020 racial and ethnic pattern.
Across all groups, life expectancy dropped to 76.60 years in 2021. That figure compares with 76.99 in 2020 and 78.86 in 2019. These are historically unusual drops.
White life expectancy dropped about a third of a year in 2021, the report found. Hispanic life expectancy was essentially flat, a statistically insignificant change, after having dropped 3.7 years in 2020 — a huge decline by any historical standard. Black Americans showed a modest rebound of 0.42 years in 2021, after seeing a decline of 3.22 years — again, a huge drop — in 2020. The report does not include estimates for Asian Americans, Native Americans or other demographics, because of data limitations.
The declines in 2020 “were enormous,” the study’s lead author, Ryan Masters, a sociologist at the University of Colorado, said in an email. “For example, the largest total decline in U.S. life expectancy occurred in 1943 (2.9 years), when U.S. deaths peaked in World War II. The 2020 declines among the Hispanic and non-Hispanic Black populations surpassed this historical decline from World War II.”
The 2020 decline, which was much more severe than what was seen in other wealthy countries, continued in 2021, to the surprise of study co-author Steven Woolf, a public health physician and director emeritus of the Center on Society and Health at Virginia Commonwealth University. A year ago, he said, he gave interviews discussing the dismal 2020 numbers and assumed the newly approved vaccines would reverse the overall downward trend.
“I was naively optimistic that we might begin to rebound and start making our way back to pre-pandemic levels,” Woolf said.
The new analysis reveals important statistics, said Gregg Gonsalves, a Yale School of Public Health epidemiologist, but is also “heartbreaking” for the “real lives lost.” He was not involved in the study.
“Yes, greater coverage of vaccination may have stemmed some of this suffering,” he said, “but we also have had an overriding desire to put the pandemic behind us for over a year now in the United States, which shaped our decisions to forgo basic protections at a personal and community level, throwing us all into harm’s way.”
The study was posted Thursday on the MedRxiv preprint server that has been the repository of more than 17,000 pandemic-related research papers over the past two years. These papers pass through a screening process but are not yet peer-reviewed in any traditional sense. Woolf said the study will be submitted imminently to a scientific journal. He said he and his colleagues felt the data was so compelling that it needed to be made public as soon as possible, which is why they submitted it to the preprint server instead of going through a formal peer review.
The researchers used modeling to analyze the changes in U.S. life expectancy, relying heavily on official data for 2018 to 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention’s National Center for Health Statistics. Woolf said previous reports using the same modeling have been proved accurate when final numbers from the CDC were published.
Historically, life expectancy rises. The gains have come as infant mortality became less common and modern medicine treated infectious diseases, cancer and other common causes of premature death. But in recent years the United States has seen life expectancy flatten or even go in a dire direction.
The country has a “health disadvantage,” as public health experts put it, compared with other wealthy countries that have seen greater gains in life expectancy.
“Simply speaking, the United States has failed to keep pace with the improvements in life expectancy enjoyed in other peer countries,” Masters said.
There are many social, economic, medical and political factors that may play into this trend, and it remains the subject of research. One obvious factor in the past decade has been the drug overdose crisis, fueled largely by the spread of opioids, which eroded improvements in life expectancy and contributed to a decline for several years.
Masters said social factors are probably drivers in both the long-term erosion of life expectancy in the United States compared with peer countries and the decline in the pandemic years, including rising inequality, systemic racism and financial insecurity.
Life expectancy is not a prediction of how long a newborn will live, nor does it set limits on any individual’s likely life span. It is a statistical snapshot of a nation’s health at a given point in time because it summarizes the population’s death rates — and it offers one way to understand some of the mortality consequences of the pandemic.
“Most of this catastrophic swing in life expectancy has to do either with people dying from the virus itself or secondary consequences produced by the pandemic,” Woolf said.
What’s significant, he added, was that the decline continued even though vaccine was available starting in late 2020. The role of vaccine hesitancy in the decline of White life expectancy is speculative, the study authors acknowledged.
“It’s hard to imagine that willingness to be vaccinated is not a piece of that puzzle,” said Laudan Aron, a senior fellow at the Urban Institute and co-author of the study. Over two years of the pandemic, the United States dropped just under two years of life expectancy further behind its peers.
“The life expectancy gap between the United States and its peer-income countries is now over five years, which is an incredible gap,” she said. “Death and life expectancy? That’s the ultimate marker of what it means to live in a country.”
The coronavirus threat was “superimposed” on many Americans already coping with increased income inequality, reduced public health investment, widespread obesity and pollution, said Philip Landrigan, a biologist at Boston College who works on global public health.
“They put an awful lot of people at risk,” he said. “When something like covid comes along, it hits disproportionately on those people at risk.”
The total U.S. decline in 2021 of 0.39 years is larger than the decline among Whites of 0.34. The difference was probably caused by lower life expectancy among Native Americans and Alaska Natives. The populations of those groups are too small for estimates to be done separately.
U.S. men suffered a larger decline than women, widening the difference in life expectancy from just over five years in 2019 to just under six years in 2021.
Critics of President Biden have pointed out that deaths from the pandemic were higher in 2021 than in 2020, the final full year of President Donald Trump’s tenure. Woolf said that view overlooks the fact that public health policies here are largely in the hands of state and local governments, and as a result there have been many different responses to the pandemic.
And the disparity between the United States and the peer countries suggests that the bad numbers from 2021 were not simply due to the delta and omicron variants sweeping through the country and driving up the death toll from covid-19, Woolf said. Those surges were most deadly in areas with low levels of vaccination, he said.
“Those same variants swept through the other comparison countries, but none of them experienced the same loss of life we saw in the United States,” Woolf said.
Masters said in an interview Thursday, “We’re really bucking the trends here in a negative way.”
He noted that Hispanic men in the United States lost more than four years of life expectancy in 2020 and did not see a rebound in 2021. The death rates among Hispanic men ages 40 to 60 jumped 50 percent between 2019 and 2020, Masters said.
“It’s shocking. It’s devastating. It’s absolutely horrific,” he said.
