‘Truly alarming’: Life expectancy gap in the US now up to 20 years

Key takeaways:

• The life expectancy gap in the U.S. increased by nearly 8 years from 2000 to 2021.
• Improvements in life expectancy were seen in Black individuals.

The life expectancy gap in the United States widened to over 20 years in the last 2 decades, with significant variations in life expectancy across diverse populations, study results published in The Lancet revealed.

Certain populations, including American Indian or Alaska Native individuals, saw declines in life expectancy due to health care barriers that “require immediate action,” the researchers wrote.

“The extent and magnitude of health disparities in American society are truly alarming in a country with the wealth and resources of the [U.S.],” Christopher J.L. Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation Overview and study co-author, said in a press release. “These disparities reflect the unequal and unjust distribution of resources and opportunities that have profound consequences on well-being and longevity, especially in marginalized populations.”

Murray served as lead author of the 2006 Eight Americas study that identified life expectancy gaps of 12.8 years for women and 15.4 years for men across eight demographic groups. In this updated analysis, Murray and colleagues assessed life expectancy trends since 2000 by dividing the U.S. population into 10 “Americas,” which are demographic groupings based on variables such as race and ethnicity, geographic location and metropolitan status. This iteration added two more groups comprising Latino individuals in the U.S.

The 10 Americas comprised:

• America 1, which included Asian individuals;
• America 2, which included Latino individuals in other countries;
• America 3, which included white, Asian, American Indian or Alaskan Native individuals in other countries;
• America 4, which included white individuals in nonmetropolitan and low-income Northlands;
• America 5, which included Latino individuals in the Southwest;
• America 6, which included Black individuals in other countries;
• America 7, which included Black individuals in highly segregated metropolitan areas;
• America 8, which included white individuals in low-income Appalachia and the Lower Mississippi Valley;
• America 9, which included Black individuals in the nonmetropolitan and low-income South; and
• America 10, which included American Indian or Alaska Native individuals in the West.

The researchers found a gap of 12.6 years (95% uncertainty interval [UI], 12.2-13.1) between the Americas with the highest and lowest life expectancy in 2000, which increased to:

• 13.9 years (95% UI, 12.6-15.2) in 2010;
• 15.8 years (95% UI, 14.4-17.1) in 2019;
• 18.9 years (95% UI, 17.7-20.2) in 2020; and
• 20.4 years (95% UI, 19-21.8) in 2021.

Life expectancy increased in nine of the Americas between 2000 to 2010, but only six of the Americas saw life expectancy grow between 2010 and 2019.

Improvement in life expectancy between 2010 and 2019 also came at a much slower pace, possibly due to increases in homicides and drug overdoses and a slowdown in the reductions of CVD mortality, Murray and colleagues suggested..

All 10 Americas saw their life expectancy decline in the first year of the COVID-19 pandemic, with decreases ranging from 1.4 years (95% UI, 1.4-1.5) to 5.3 years (95% UI, 4.9-5.8), whereas only three Americas partly rebounded in 2021.

America 10 served as the only group to experience significant declines in life expectancy from 2000 to 2019 and had the largest decline from 2019 to 2021.

The three Black Americas had some of the largest gains in life expectancy before 2020 — increasing by as much as 3.7 years (95% UI, 3.5-3.9) — with America 6 passing the life expectancy of America 8 from 2010 onward except in 2020.

“It’s likely that long-term improvements in education available to Black children and young adults in recent decades, as well as reductions in homicide rates and deaths from HIV/AIDS — causes of death that have disproportionately impacted Black Americans — may have contributed to these noteworthy gains for Black Americans,” Thomas J. Bollyky, a senior fellow at the Council of Foreign Relations and study co-author, said in the release.

The researchers pointed out that factors like systematic discrimination, higher rates of unemployment and lower rates of health insurance and educational attainment contribute to health disparities among American Indian and Alaskan Native individuals.

“Policymakers must take collective action to invest in equitable health care, education, and employment opportunities and challenge the systemic barriers that create and perpetuate these inequities so that all Americans can live long, healthy lives regardless of where they live and their race, ethnicity, or income,” Murray said in the release.

References:

• Deeply entrenched racial and geographic health disparities in the USA have increased over the last two decades—as life expectancy gap widens to 20 years. Available at: https://www.healthdata.org/news-events/newsroom/news-releases/lancet-deeply-entrenched-racial-and-geographic-health. Published Nov. 21, 2204. Accessed Nov. 22, 2024.
• Dwyer-Lindgren L, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01495-8.