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Effect of the Covid-19 Pandemic in 2020 on Life Expectancy BMJ: First Published As 10.1136/Bmj.N1343 on 23 June 2021

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Effect of the Covid-19 Pandemic in 2020 on Life Expectancy BMJ: First Published As 10.1136/Bmj.N1343 on 23 June 2021 RESEARCH Effect of the covid-19 pandemic in 2020 on life expectancy BMJ: first published as 10.1136/bmj.n1343 on 23 June 2021. Downloaded from across populations in the USA and other high income countries: simulations of provisional mortality data Steven H Woolf,1 Ryan K Masters,2 Laudan Y Aron3 1Center on Society and Health, ABSTRACT decreased by 1.87 years (to 76.87 years), 8.5 times Virginia Commonwealth OBJECTIVE the average decrease in peer countries (0.22 years), University School of Medicine, To estimate changes in life expectancy in 2010-18 widening the gap to 4.69 years. Life expectancy in Richmond, VA, USA and during the covid-19 pandemic in 2020 across the US decreased disproportionately among racial 2Department of Sociology, Health and Society Program and population groups in the United States and to and ethnic minority groups between 2018 and Population Program, Institute of compare outcomes with peer nations. 2020, declining by 3.88, 3.25, and 1.36 years in Behavioral Science, University Hispanic, non-Hispanic Black, and non-Hispanic of Colorado Population Center, DESIGN University of Colorado Boulder, Simulations of provisional mortality data. White populations, respectively. In Hispanic and CO, USA non-Hispanic Black populations, reductions in life SETTING 3Urban Institute, Washington, expectancy were 18 and 15 times the average in US and 16 other high income countries in 2010- DC, USA peer countries, respectively. Progress since 2010 in 18 and 2020, by sex, including an analysis of US Correspondence to: S H Woolf reducing the gap in life expectancy in the US between outcomes by race and ethnicity. [email protected] Black and White people was erased in 2018-20; life (or @shwoolf on Twitter ORCID 0000-0001-9384-033X) POPULATION expectancy in Black men reached its lowest level since Data for the US and for 16 other high income countries Additional material is published 1998 (67.73 years), and the longstanding Hispanic online only. To view please visit from the National Center for Health Statistics and the life expectancy advantage almost disappeared. the journal online. Human Mortality Database, respectively. CONCLUSIONS Cite this as: BMJ 2021;373:n1343 MAIN OUTCOME MEASURES http://dx.doi.org/10.1136/bmj.n1343 The US had a much larger decrease in life expectancy Life expectancy at birth, and at ages 25 and 65, between 2018 and 2020 than other high income Accepted: 24 May 2021 by sex, and, in the US only, by race and ethnicity. nations, with pronounced losses among the Hispanic Analysis excluded 2019 because life table data were and non-Hispanic Black populations. A longstanding not available for many peer countries. Life expectancy and widening US health disadvantage, high death http://www.bmj.com/ in 2020 was estimated by simulating life tables from rates in 2020, and continued inequitable effects estimated age specific mortality rates in 2020 and on racial and ethnic minority groups are likely the allowing for 10% random error. Estimates for 2020 are products of longstanding policy choices and systemic reported as medians with fifth and 95th centiles. racism. RESULTS Between 2010 and 2018, the gap in life expectancy Introduction between the US and the peer country average on 30 September 2021 by guest. Protected copyright. In 2020, covid-19 became the third leading cause of increased from 1.88 years (78.66 v 80.54 years, death in the United States1 and was thus expected to respectively) to 3.05 years (78.74 v 81.78 years). substantially lower life expectancy for that year (box Between 2018 and 2020, life expectancy in the US 1). The US had more deaths from covid-19 than any other country in the world and among the highest per WHAT IS ALREADY KNOWN ON THIS TOPIC capita mortality rates.5 This surge in deaths prompted speculation that the US would have a larger decrease Because of systemic factors in the United States, the gap between life in life expectancy in 2020 than peer nations, but expectancy in the US and other high income countries has been widening for empirical evidence has not been published. Americans decades entered the pandemic at a distinct disadvantage relative In 2020, the US had more deaths from the covid-19 pandemic than any other to other high income peer nations: improvements in country, but no study has quantified how the year’s large number of deaths overall life expectancy have not kept pace with those affected life expectancy in the US or the gap with peer countries in peer countries since the 1980s,6 and in 2011, life WHAT THIS STUDY ADDS expectancy in the US plateaued and then decreased for three consecutive years, further widening the gap in Between 2018 and 2020, largely because of the covid-19 pandemic, life mortality with peer nations.7 expectancy in the US decreased by 1.87 years, 8.5 times the average decrease in The effect of the pandemic on life expectancy peer countries, widening the gap in life expectancy with peer countries to 4.69 extends beyond deaths attributed to covid-19.8 Studies years have found an even larger number of excess deaths In the US, decreases in life expectancy in Hispanic and non-Hispanic Black during the pandemic, inflated by undocumented people were about two to three times greater than in the non-Hispanic White deaths from covid-19 and by deaths from non- population, reversing years of progress in reducing racial and ethnic disparities, covid-19 causes resulting from disruptions by the and lowering the life expectancy of Black men to 67.73 years, a level not seen pandemic (eg, reduced access to healthcare, economic since 1998 pressures, and mental health crises).9-12 Some racial the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 1 RESEARCH and by sex). Estimates of life expectancy for 2010- Box 1: Meaning of life expectancy during a pandemic BMJ: first published as 10.1136/bmj.n1343 on 23 June 2021. Downloaded from 18 were calculated from official life tables and were Life expectancy is a widely used statistic for summarizing a population’s mortality modeled for 2020. Estimates for 2019 would have rates at a given time.2 It reflects how long a group of people can expect to live were been preferable to determine the effect of the covid-19 they to experience at each age the prevailing age specific mortality rates of that year.3 pandemic but life table data were unavailable for many Estimates of life expectancy are sometimes misunderstood. We cannot know the peer countries. Life expectancy in the US is estimated future age specific mortality rates for people born or living today, but we do know the to have increased by only 0.1 years between 2018 and current rates. Computing life expectancy (at birth, or at ages 25 or 65) based on these 2019,18 however, and therefore the changes seen in rates is valuable for understanding and comparing a country’s mortality profile over life expectancy between 2018 and 2020 are largely time or across places at a given point in time. Estimates of life expectancy during the attributable to the events of 2020. covid-19 pandemic, such as those reported here, can help clarify which people or Data for peer countries did not include information places were most affected, but they do not predict how long a group of people will on race or ethnicity. US data were examined for live. This study estimated life expectancy for 2020. Life expectancy for 2021 and three racial and ethnic groups that constitute more subsequent years, and how quickly life expectancy will rebound, cannot be calculated than 90% of the total population: Hispanic, non- until data for these years become available. Although life expectancy is expected Hispanic Black, and non-Hispanic White populations. to recover in time to levels before the pandemic, past pandemics have shown that Although many US individuals self-identify as Latino survivors can be left with lifelong consequences, depending on their age and other or Latina, we used Hispanic to maintain consistency socioeconomic circumstances.4 with data sources. White and Black populations in this study refer to people in these racial groups who and ethnic populations and age groups have been do not identify as Hispanic or Latinx.19 Estimates for disproportionately affected.13-15 Research on how the other important racial groups, such as Asian, Pacific pandemic has affected life expectancy is only just Islander, and Native American (American Indians and emerging.16 17 Few studies have examined reductions Alaskan Natives) could not be calculated because the in 2020 life expectancy across racial and ethnic National Center for Health Statistics does not provide groups, and none has compared the decline in the US official life tables for these populations. with other countries. US life tables for 2010-18 were obtained from the National Center for Health Statistics.20-28 Weekly Methods age specific death counts for all men and women in We estimated life expectancy at birth and at ages 25 the US and for Black, White, and Hispanic men and and 65, examining the US population (in aggregate women in the US for the years 2018 and 2020 were http://www.bmj.com/ and by sex, and by race and ethnicity) and the obtained from the National Center for Health Statistics’ populations of 16 high income countries (in aggregate AH (ad hoc) Excess Deaths by Sex, Age, and Race file.29 Mid-year population estimates by age, sex, and race and ethnicity for men and women in the US for Visual Abstract Life expectancy in the wake of covid-19 2015-19 were obtained from the US Census Bureau.30 The US has been hit harder than its peers Population counts for 2020 were estimated from age on 30 September 2021 by guest.
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