American life expectancy was already lagging, the pandemic sped it up

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American life expectancy has been lagging for decades. The pandemic sent it into a tailspin.

The average American life expectancy fell to 76.1 years in 2021, show federal health statistics, cutting nearly a year from the expected lifetime of someone born today in the United States. The plunge reflected both the covid pandemic and the intensification of overdoses, heart and liver disease, suicide, and other chronic ills that have long plagued the health of the American public.

Even before the pandemic, U.S. life expectancy had peaked in 2014 at 78.8 years at birth, then fallen and flattened in ensuing years, before the advent of covid. But the National Center for Health Statistics (NCHS) report released on Wednesday finds U.S. life expectancy in 2020 and 2021 dropped a combined 2.7 years, the largest two-year fall in nearly a century.

“Since the beginning of the 20th century, life expectancy has been generally increasing on an annual basis, except for some periods like the 1918 influenza and now, with the pandemic,” said Elizabeth Arias, the lead NCHS author on the report. Life expectancy numbers are a snapshot of death trends in the U.S. population, she added, “where there was a dramatic slowdown and some reversals” after 2010.

“What we are seeing is our health being worse than it should have been long before covid, and then covid exacerbating that underlying poor health,” said Sandro Galea, dean of the School of Public Health at Boston University. Already undermined, public health collapsed like a flooding house with a crumbling foundation, he suggested, when it met the pandemic.

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“These data show how far we have to go to rethink health in the U.S.,” said Galea.

Without the pandemic, said Arias, statistical analyses suggest decreased deaths from diseases like influenza, cancer, Alzheimer’s and lung disease would have outweighed increases in deaths from other causes, leading to a net increase in U.S. life expectancy in 2021. But there’s no way to prove that, and the possibility cannot be ruled out that more people with those diseases might have died of them last year in the absence of the pandemic. “We haven’t been talking about influenza a lot the last two years,” said Arias.

Covid remains a major source of mortality

Nearly 400 Americans a day are still dying of covid, two years into the pandemic. Overall, the disease has killed around 1.04 million people in the U.S., driving much of the two-year drop in life expectancy — 74 percent of it in 2020 and 50 percent in 2021 — but not all of it. Overdose deaths added to the toll, along with heart disease, chronic liver disease and suicide. All of those problems were already worsening for decades before this one. “It’s also concerning how reductions in [health] screening during the pandemic may have long-term effects on life expectancy,” said Troy Quast, a health economist at the University of South Florida.

Chronic health ailments, along with overdoses, have continued to chip away at U.S. life expectancy underneath the pandemic, the data show. U.S. overdose deaths are now estimated at around 109,000 in the last 12-month period since March, with illicit fentanyl now killing about as many people in and of itself, around 70,000 a year, as the number of total U.S. overdose deaths in 2019, the last year before the pandemic.

Most worrying are the overdose and liver disease (tied to alcoholism) deaths, “which may not necessarily improve as covid enters endemic status,” said Quast, given their role in earlier declines in life expectancy. Public health researchers have found that overdose deaths have followed a surprisingly smooth exponential curve upward since the late 1970s. The finding points to an economic and cultural malaise behind the overdose epidemic that is far more significant than the industrial innovation of Mexican cartels now manufacturing illicit fentanyl to sell on the drug market.

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The U.S. bucks the rich country trend to longer lives

Years before the pandemic, a long-running decline in U.S. life expectancy was already coming into focus among public health researchers, who found that self-reports of health were getting worse, that poor white women were living shorter lives and that even well-off white men were seeing life expectancy increases fall behind those of their peers in other wealthy nations in the 1990s. Absolute declines in life expectancy were observed for poor minorities in states with weaker healthcare systems, “starting at least as early as 1980,” said the report led by Peter Muennig, a health policy researcher at Columbia University.

The pandemic sharpened those trends, with American Indian or Alaska Natives seeing a shocking 6.6-year drop in their life expectancy over the last two years, despite high initial vaccination rates, to 65.1 years. Life expectancy for men in that category is now 61.5 years (lower than Bangladesh’s total life expectancy by about eight years). Hispanic life expectancies fell by 4.2 years, and Black people saw a four-year drop in that same time.

“It’s very difficult to understand that this is all happening in one country, where you are seeing populations that experience life expectancies seen in the poorest countries in Africa,” said Arias. In the Americas, only Haiti has a life expectancy like American Indian or Alaska Natives in the U.S.

Linked to those racial declines in life expectancy is the role of poverty and unequal access to healthcare, said Quast: “It’s clear that class issues have a very significant effect.”

Until the pandemic, Hispanics in the U.S. had defied the link between poverty and lowered life expectancy, an observation attributed to less smoking, immigrants generally being healthier and having strong family supports. However, that changed in the pandemic, said Arias, erasing those gains, likely because many worked in service jobs that exposed them to the coronavirus. “This really illustrates the links between socioeconomic factors and life expectancy,” she said.

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In the last decade, Princeton University economists Anne Case and Angus Deaton have suggested that poor whites have been swept up by the same kinds of economic dislocation that cuts into the life expectancies of Black, Hispanic and Native Americans. These “deaths of despair” are driven by declining wages and deindustrialization that leads to poorer healthcare and other ills, such as addiction and alcoholism, they argue, offering an economic perspective on the long-term concerns about the overall unhealthiness of American life voiced earlier by public health researchers.

“To me, this is one of the biggest stories of the last 10 years,” said Quast. Increased life expectancy was once thought assured in the absence of wars or massive natural disasters, but the halt to U.S. lives growing longer, even before the sharp drop seen in the pandemic, has turned those expectations upside down.

“Obviously people of different political persuasions will have different ideas of how to address this situation, but seemingly all parties should view this with equal alarm,” said Quast.

Thanks to Lillian Barkley for copy editing this article.

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