Life Expectancy Changes During the COVID-19 Pandemic, 2019-2021: Highly Racialized Deaths in Young and Middle Adulthood in the United States as Compared With Other High-Income Countries

Abstract

We estimated changes in life expectancy between 2019 and 2021 in the United States (in the total population and separately for 5 racial/ethnic groups) and 20 high-income peer countries. For each country's total population, we decomposed the 2019-2020 and 2020-2021 changes in life expectancy by age. For US populations, we also decomposed the life expectancy changes by age and number of coronavirus disease 2019 (COVID-19) deaths. Decreases in US life expectancy in 2020 (1.86 years) and 2021 (0.55 years) exceeded mean changes in peer countries (a 0.39-year decrease and a 0.23-year increase, respectively) and disproportionately involved COVID-19 deaths in midlife. In 2020, Native American, Hispanic, Black, and Asian-American populations experienced larger decreases in life expectancy and greater losses in midlife than did the White population. In 2021, the White population experienced the largest decrease in US life expectancy, although life expectancy in the Native American and Black populations remained much lower. US losses during the pandemic were more severe than in peer countries and disproportionately involved young and middle-aged adults, especially adults of this age in racialized populations. The mortality consequences of the COVID-19 pandemic deepened a US disadvantage in longevity that has been growing for decades and exacerbated long-standing racial inequities in US mortality.

Keywords: COVID-19; United States; coronavirus disease 2019; health disparities; life expectancy; mortality; systemic racism.

Figure 1

Changes in life expectancy (years) in aggregate for the United States and 20 high-income peer countries and by race/ethnicity in the United States, 2019–2020 and 2020–2021 (A) and 2019–2021 (B). Gray vertical lines indicate the “90% uncertainty range” based on 10% random error in 2021 mortality risks.

Figure 2

Life expectancy at birth (years) in the United States (red) and 20 high-income peer countries (gray) and the peer country mean (black), 2019, 2020, and 2021.

Figure 3

Contribution of age to changes in life expectancy at birth (years) in the United States and 20 high-income peer countries (mean), 2019–2020 (A) and 2020–2021 (B).

Figure 4

Contribution of age to changes in US life expectancy at birth (years), by race/ethnicity, 2019–2020 (A) and 2020–2021 (B). AI/AN, American Indian/Alaska Native; NH, non-Hispanic.

Figure 5

Contributions of age and coronavirus disease 2019 (COVID-19) deaths to changes in US life expectancy at birth (years), by race/ethnicity, 2019–2020 (left column) and 2020–2021 (right column). AI/AN, American Indian/Alaska Native.