Changes in Life Expectancy Between 2019 and 2020 in the US and 21 Peer Countries

Abstract

This cross-sectional study examines death counts in the US and 21 peer countries between 2019 and 2020 to evaluate life expectancy disparities between the US and peer countries and racial disparities within the US.

Key Points

Question

How did US life expectancy change between 2019 and 2020, and how did that compare with changes in life expectancy in 21 other high-income countries?

Findings

In this cross-sectional study, calculations of life expectancy based on official death counts revealed that US life expectancy decreased by 1.87 years overall, and by 3.70 years in Hispanic populations and 3.22 years in non-Hispanic Black populations. The decrease in life expectancy in peer countries was a mean of 0.58 years, with no country experiencing a decrease rivaling that of the US.

Meaning

The large and highly racialized decreases in US life expectancy underscore the growing US health disadvantage relative to peer countries and the need for policies that prioritize health and equity.

Abstract

Importance

Prior studies reported that US life expectancy decreased considerably in 2020 because of the COVID-19 pandemic, with estimates suggesting that the decreases were much larger among Hispanic and non-Hispanic Black populations than non-Hispanic White populations. Studies based on provisional data suggested that other high-income countries did not experience the large decrease in life expectancy observed in the US; this study sought to confirm these findings according to official death counts and to broaden the pool of comparison countries.

Objective

To calculate changes in US life expectancy between 2019 and 2020 by sex, race, and ethnicity and to compare those outcomes with changes in other high-income countries.

Design, Setting, and Participants

This cross-sectional study involved a simulation of life tables based on national death and population counts for the US and 21 other high-income countries in 2019 and 2020, by sex, including an analysis of US outcomes by race and ethnicity. Data were analyzed in January 2022.

Exposures

Official death counts from the US and 21 peer countries.

Main Outcomes and Measures

Life expectancy at birth and credible range (CR) based on 10% uncertainty.

Results

Between 2019 and 2020, US life expectancy decreased by a mean of 1.87 years (CR, 1.70-2.03 years), with much larger decreases occurring in the Hispanic (3.70 years; CR, 3.53-3.87 years) and non-Hispanic Black (3.22 years; CR, 3.03-3.40 years) populations than in the non-Hispanic White population (1.38 years; CR, 1.21-1.54 years). The mean decrease in life expectancy among peer countries was 0.58 years (CR, 0.42-0.73 year) across all 21 countries. No peer country experienced decreases as large as those seen in the US.

Conclusions and Relevance

Official death counts confirm that US life expectancy decreased between 2019 and 2020 on a scale not seen in 21 peer countries, substantially widening the preexisting gap in life expectancy between the US and peer countries. The decrease in US life expectancy was experienced disproportionately by Hispanic and non-Hispanic Black populations, consistent with a larger history of racial and ethnic health inequities resulting from policies of exclusion and systemic racism. Policies to address the systemic causes of the US health disadvantage relative to peer countries and persistent racial and ethnic inequities are essential.