Why are American lives getting shorter?

US life expectancy got worse during Covid-19, and then kept getting worse.

Life expectancy for Americans has suffered a historic drop in the last couple of years, according to new estimates from the CDC and a June preprint study. While every demographic’s life expectancy dropped in 2020 and 2021, Black, Hispanic, and Indigenous communities were hit the hardest.

Life expectancy at birth — or how long a person is expected to live if nothing in the world changes — is usually calculated by using death rate data within each age group. So while life expectancy isn’t a prediction of how long a baby born today will live, the drop reveals the scale of untimely deaths during Covid-19.

What we are seeing is the steepest drop in life expectancy since World War II.

The CDC report and other recent life expectancy research show that the pandemic’s impact has been massive, and its effects may well persist for years. The average life expectancy for all groups has gone down since 2019, from 79 years to about 76. For white and Black Americans, it’s the lowest it has been in over 25 years. And the preprint’s authors found that while other rich countries began to recover from the pandemic last year, the US has continued to decline.

The estimates for 2021 are based on provisional death rates, while data for 2019 and 2020 are final. Because every estimate takes different factors into account, it’s normal that their conclusions slightly vary. (The preprint factored in rapid uptake of Covid-19 vaccines for older populations, so its death rate estimates are lower than the CDC’s, said Ryan Masters, a social demographer at the University of Colorado Boulder and one of the preprint’s authors.)

All estimates show that life expectancy in the US has continued to decline, even as almost all rich countries have bounced back from lower life expectancies in the first year of Covid. “[The US] is one of the richest countries on the face of the planet,” said Laudan Aron, a senior fellow in the Health Policy Center at the Urban Institute and one of the co-authors of the June paper. “The fact we cannot translate our economic wealth into protecting our population and ensuring that everybody has a fair chance to live a long and healthy and productive life is a real failure.”

Why the decline in life expectancy is so stark

Before the pandemic, global life expectancy was consistently getting higher by a few months every year. Yet even in that context, there were already worrisome signals for the US. A few years ago, US life expectancy dropped slightly, by about a month, due to an increase in deaths from various diseases, like stroke and heart failure.

That drop pales in comparison to the three-year loss we’ve seen in the wake of Covid-19.

The June preprint found that the US was one of only two among 21 selected similar wealthy countries — along with Israel — in which life expectancy continued to decline last year. While most countries suffered hundreds of thousands of untimely deaths during the first year of Covid-19, once people began to get vaccinated, life expectancies for almost all the 21 countries either stayed the same or began to rise again, many up to their pre-pandemic levels.

The US started off with lower pre-Covid life expectancies than other rich countries like South Korea, France, and Australia. It has been the case for decades that the United States spends exorbitant amounts on health care, yet has worse health outcomes than comparable countries. Even before the pandemic, people in the US faced the opioid epidemic, gun violence, and higher chronic disease rates than people in other rich countries.

Many of the same underlying factors are why the US has failed to recover from Covid, according to experts. Lack of health access and a robust public health care system exacerbated Covid-19’s effects, said Noreen Goldman, a professor of demography and public affairs at Princeton University. The lack of national coordination to address the pandemic, and lower vaccination rates, said Goldman, have also been a factor in outcomes being worse in the US than other comparable countries.

Young people were dying more from Covid-19 in 2021 than 2020, said Theresa Andrasfay, a demography researcher at the University of Southern California. While age remains the biggest risk factor, more middle-aged adults who are not vaccinated are dying. Additionally, she said, high rates of chronic disease, obesity, and diabetes had not yet affected mortality statistics, but when a disease — Covid-19 — came along that had these as risk factors, “it was like lighting a match.”

Covid-19 has disproportionately affected already-vulnerable groups

In the United States, Covid-19 has affected some communities worse than others. Even pre-pandemic, life expectancies for different demographic groups were highly disparate due to structural factors, such as lack of access to health care. In 2019, the average life expectancy for Black men was 10 years lower than for white women.

“Health travels along with economic well-being, housing stability, food security,” said Aron, one of the preprint co-authors, and these circumstances are largely driven by systemic issues.

Even pre-pandemic, drivers of mortality like air pollution disproportionately affected Americans of color; Black Americans are more likely to live in areas with worse determinants of health outcomes because of racist policies like redlining. For Native Americans, said Goldman, there were already high poverty rates, unemployment, lack of water infrastructure, underlying health risk factors, and lower quality and less accessible health care.

Covid-19 only made this gap worse.

In 2020, Black Americans died from Covid-19 at twice the rate of white Americans. In the CDC’s latest estimates, while every demographic group experienced a decline in life expectancy, Native Americans, Black Americans, and Hispanic Americans all experienced more loss of life.

Men also experienced greater loss of life expectancy than women across every race/ethnicity group. As with other demographics, this was likely due to a number of factors, including men being more likely to have jobs that would expose them to the disease, behavioral differences in hand-washing and vaccines, and biological factors.

I asked Goldman, who authored (with Andrasfay) two papers about race/ethnicity disparities in life expectancy declines, about the factors that led to the particularly negative outcomes for Indigenous people. Despite a strong vaccination campaign, the pandemic exacerbated many of the factors — lack of infrastructure, chronic disease, an underfunded Indian Health Service — that had already led to lower life expectancies. “This is just an astounding loss,” she said.

Given many of the same drivers of deaths during Covid-19 were also causes of already bad US health outcomes, there’s no one policy that will turn this trend around. The same policies that will make health better overall will also make us better prepared the next time a health crisis emerges. Thinking ahead to preventing the next pandemic will also be crucial to ensuring that everyone in the US — particularly the most vulnerable populations — has the opportunity to live long, healthy lives.

When looking at statistics like this, said Aron, it’s important to think about the ripple effects of untimely deaths. Before someone dies, they may spend months suffering; and after they die, their family, friends, and community need to mourn and come to terms with their loss.

Covid-19 has been “not only a potentially mass disabling event, but a mass bereavement event,” she said. The decline in life expectancy isn’t just a blinking indicator of a national failure — it’s an index of the societal trauma that’s been playing out, over and over again, in our homes and communities.

“To experience any stalling or reduction in life expectancy is tragic,” said Masters. To see life expectancies reduced by 3, 4, 5, or 6 years, he said, is “mind-boggling and heartbreaking.”

Correction, September 7, 4:50 pm: A previous version of this story included a mistyped quote from scholar Laudan Aron. She said Covid-19 has been “not only a potentially mass disabling event, but a mass bereavement event.”