Mortality gap between United States and other high-income countries widens due to COVID-19


The study finds large drops in life expectancy for Hispanic and Black people in 2020.

Life expectancy in the U.S. dropped faster during the first year of the COVID-19 pandemic than in other industrialized nations, accelerating a gap that was already widening, according to a new study.

The study’s authors used official death counts to calculate life expectancy in the U.S. by sex and ethnicity in 2019 and 2020 and compared the outcomes with those in 21 other high-income countries. They found that U.S. life expectancy fell by a median of 1.87 years, from 78.86 to 76.99 years.

By contrast, in the 21 other countries studied the average median decrease was 0.58 years, from 82.08 to 81.50. The largest decline—1.43 years—occurred in Spain, while in New Zealand, Taiwan and South Korea life expectancy increased.

Life expectancy declines in the U.S. varied greatly by race, ethnicity and sex the study found, with the Hispanic population experiencing the greatest decrease from 81.86 to 78.16, or 3.7 years. That compares with 3.22 years among the non-Hispanic Black population (from 74.76 to 71.54 years) and 1.38 years (78.78 to 77.40 years) among White Americans.

The authors call the higher death rates among Hispanic and non-Hispanic Black populations compared with White Americans “consistent with the long history of racial and socioeconomic disparities in the U.S,” and a reflection of these groups’ “higher risk of hospitalization and death from COVID-19 and vulnerability to conditions causing non-COVID deaths.”

Women in the U.S. saw a decline in median life expectancy of 1.51 years, from 81.39 to 79.88, while for men the decrease was 2.13 years (76.32 to 74.19). Among peer countries the average median decrease for women was .50 years (84.29 to 83.79) and .64 years (79.85 to 79.21) for men.

The authors note that downward trends in American life expectancy began before the pandemic and likely have “systemic origins.”

“Compared with other high-income countries, the US ranks poorly on social and economic conditions, health-promoting environments and infrastructure, social well-being and access to health care and health insurance,” they say. Moreover, the U.S. doesn’t have universal health care and offers weaker protections for public health and safety.

Even when prepandemic mortality rates return, the authors write, “without corrective action U.S. residents will continue to die at higher rates than their counterparts in other advanced democracies…until the country makes policy choices that optimize health, well-being, and equity.”

The study, “Changes in Life Expectancy Between 2019 and 2020 in the US and 21 Peer Countries,” was published April 13 on JAMA Network Open.

This article was originally published by sister publication Medical Economics.

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Courtney Nelson, MD
Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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