US Life Expectancy Significantly Dropped Compared to Peer Countries in 2020

Steven H. Woolf, MD, MPH

The overall life expectancy of Americans decreased by nearly 2 years from 2019 to 2020—a more than 3-fold worse rate than the mean decreases observed across 21 peer countries at that time, according to new findings.

In new analysis of nationally representative mortality data during the COVID-19 pandemic, a team of investigators reported the US fared significantly worse than peer countries in mortality risk increases in 2020, with minority populations being the most severely impacted by life expectancy decreases. The findings highlight the relevant health and economic disadvantages burdening the diverse US population headed into the pandemic.

Led by Steven H. Woolf, MD, MPH, of the Center on Society and Health at Virginia Commonwealth University School of Medicine, investigators sought to calculate change in life expectancy among Americans between 2019 and 2020 based on sex, race and ethnicity—and to compare such outcomes with changes observed in similar high-income countries.

Life expectancy is a generally misunderstood term, investigators wrote: it reflects the length of time a group of people can expect to live—were they to experience at each age the prevailing age-specific mortality rates of that year. It was previously observed that the first year of COVID-19 (2020) was associated with large decreases in life expectancy in many countries including the US.

“Give that US COVID-19 mortality and excess deaths were among the highest in the world, the decline in US life expectancy likely exceeded declines in other countries, but research confirming this hypothesis is limited,” investigators wrote. “A larger decrease in life expectancy in the US than in other countries would be important because the country entered the pandemic with the lowest life expectancy among high-income countries, an ignominious status it has held for decades.”

Woolf and colleagues conducted a cross-sectional modeling study by simulating life tables based on national death and population counts for the US and 21 other-income countries including Canada, England, France, Italy, New Zealand, Spain, and on. Life expectancy change was stratified by population sex for each country, and race and ethnicity for the US.

US life expectancy decreased by a median 1.87 years (credible range [CR], 1.70 – 2.03), from 78.86 years in 2019 to 76.99 years in 2020. Investigators observed a greater decrease among men (2.13 years; CR, 1.96 – 2.30) than women (1.51; CR, 1.35 – 1.67).

Decreases were even more pronounced among the Hispanic population (3.70; CR, 3.53 – 3.87) and non-Hispanic Black population (3.22; CR, 3.03 – 3.40). Life expectancies for each population were 71.54 and 78.16 years, respectively, in 2020. The non-Hispanic White population experienced just a 1.38-year decrease (CR, 1.21 – 1.54) in 2020.

Mean life expectancy change across the 21 observed peer countries was just 0.58 years (CR, 0.42 – 0.73) from 2019 to 2020. Mean life expectancy among the countries was 81.50 years in 2020—4.51 years greater than that of the US.

“No peer country experienced decreases in life expectancy as large as those seen in the US,” investigators wrote.

The team concluded the findings contribute toward an observed downward trend in US life expectancy that spans back to 2010, with rates reflecting burden of cause-specific deaths due to drug overdose, cardiometabolic disease and other chronic diseases—each primarily exacerbated among different races and ethnicities.

Contrasting against the less-impacted life expectancy rates among the 21 peer 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,” investigators wrote.

“Given these systemic vulnerabilities, the US entered the COVID-19 pandemic in a fundamentally weakened state,” they wrote. “These preexisting conditions, combined with mismanagement of federal, state, and local pandemic responses and factional public resistance to practices to prevent viral transmission, drove US death rates above these experienced by other countries.”

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