COVID-19 ‘eliminating’ recent gains in US life expectancy
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The COVID-19 pandemic may wipe out life expectancy gains that took more than a dozen years for the United States to achieve, according to researchers.
The CDC estimates that, as of Jan. 20, 2021, more than 400,300 people in the U.S. have died of COVID-19.
“An important but as of yet unanswered question concerns the impact of this exceptional number of deaths on life expectancy for the entire nation as well as the consequences for marginalized groups,” Theresa Andrasfay, PhD, MA, a postdoctoral fellow at the Leonard Davis School of Gerontology at the University of Southern California and Noreen Goldman, DSc, a professor of demography and public affairs at Princeton University, wrote.
The researchers used birth, death and census data to estimate changes in U.S. life expectancy in 2020. Some of their projections, published in the Proceedings of the National Academy of Sciences, showed that:
- across all races and ethnicities, life expectancy in 2020 dropped 1.13 years to 77.48 years, the lowest since 2003;
- across all races and ethnicities, life expectancy for those aged 65 years dropped 0.87 year; and
- life expectancy for Blacks and Latinos at birth declined 2.1 and 3.05 years, respectively, which is three to four times greater than the 0.68-year reduction for whites.
According to Andrasfay and Goldman, the projections suggest a nearly 40% increase in the Black-white life expectancy gap from 3.6 years to more than 5 years, “eliminating progress” the U.S. made in reducing this differential since 2006. In addition, Latinos’ survival advantage over whites dropped by 70% from 3 years to less than 1 year.
The researchers said the impact of the estimated decline in overall life expectancy “is about 10 times as large as the worrisome annual decreases several years ago that were attributed largely to drug overdoses, other external causes, and respiratory and cardiovascular diseases.”
“The U.S. reduction in 2020 life expectancy is projected to exceed that of most other high-income countries, indicating that the United States — which already had a life expectancy below that of all other high-income, developed nations prior to the pandemic — will see its life expectancy fall even farther behind its peers,” Andrasfay and Goldman wrote.
Perspective
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The findings of this study are not unexpected. The difference in life expectancy is quite shocking.
There are multiple ways to reverse Andrasfray’s and Goldman’s projections. We need to fix systems that eliminate disparities and improve access to care. Physicians can advocate for a health care system where everyone is included, and no one is left out. Within physicians’ own practices, they need to make sure that patients do not miss their appointments, that patients get the care — whether it be routine or preventive — that they need.
Physicians also need to do a lot of professional soul searching. We know that there is a difference in the quality of care that is received by minorities in clinical practice, often due to unconscious bias. We should ask ourselves questions such as, “Am I being biased and not giving them enough pain medication because of my views? Am I treating them any different in my practice?” Physicians with patients who are not proactive might want to ask themselves, “Why aren’t these patients showing up?” It may be because they do not feel comfortable in your practice. It may be because they do not understand the need to come back. Even when bias is not present, we need to come up with creative solutions to help all of our patients continuously receive health care.
Member, National Academy of Medicine of the National Academies of Science, Engineering and Medicine
Perspective
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The findings of Andrasfray and Goldman, especially when we look at the disparate death rates for African Americans and Latinx populations vs. those of European Americans in the United States, closely align with those from the CDC. Therefore, they are not surprising. Overall, the study speaks to the overwhelming impact and the breadth of COVID-19’s impact on the African American communities of the United States.
There are two immediate things this country needs to do to reverse these trends. First, invoke the Defense Production Act to accelerate production of personal protective equipment (PPE) until we have an adequate, overflowing, affordable (if not free) supply of PPE for health care workers, other essential workers, long-term care facility residents, homeless people, grocery store shoppers and anyone else in the United States I may have missed. Second, we should use the same act to amplify production of diagnostic testing and point-of-care testing so that is readily available across the country no matter where one lives. These strategies have not been optimized and are needed to mitigate and stomp out COVID-19.
Professor of family medicine, The Ohio State University Wexner Medical Center
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