This would be the largest single-year decline in at least 40 years, the researchers note. The study, published January 14 in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), predicted that white Americans would see a decrease in life expectancy of .68 years, to 77.84 years. The researchers projected more dramatic drops in life expectancy among people of color. For Black Americans, life expectancy would shorten by 2.1 years, to 72.78 years; Latinos would see a drop of 3.05 years, to 78.77 years. “Our findings underscore the extent of racial disparities in COVID-19 mortality,” says one of the study’s coauthors, Theresa Andrasfay, PhD, a postdoctoral fellow at the Leonard Davis School of Gerontology at the University of Southern California in Los Angeles. Earlier evidence revealed the disproportionate impact of COVID-19 on Black and Latino Americans, says Dr. Andrasfay, but differences in the ages of people dying from the virus among diverse racial and ethnic groups obscured the full extent of these disparities.
Life Expectancy, Explained
Life expectancy at birth represents the average number of years that someone can expect to live given the year they were born. In 2019, life expectancy at birth (for babies born in 2019) for the total population in the United States was 78.8 years, according to the Centers for Disease Control and Prevention (CDC). Another way that experts measure longevity is by assessing how much longer people of a certain age could expect to live in a given year. Using that measure, in 2019 life expectancy at age 65 for the total population was 19.6 years (meaning a 65-year-old could expect to live almost 20 more years, on average), according to the CDC.
A ‘Backward Step’ in the Journey Toward Health Equality
For the new study, investigators compared life expectancy at birth and at age 65 for 2020, looking at the total U.S. population as well as different racial and ethnic groups. Then they projected life expectancy for four different scenarios — one in which the COVID-19 pandemic never happened measured against three others — using COVID-19 mortality projections by the University of Washington’s Institute for Health Metrics and Evaluation along with data from the National Center for Health Statistics. The three scenarios predicted different levels of mortality caused by the pandemic, with the researchers focusing on results for the middle projection. “This report adds to the body of work that continues to document and show what a disproportionate impact the pandemic is having on Latino, Black, and other minority communities in our country,” says Leo Morales, MD, MPH, PhD, a professor of medicine and the chief diversity officer at the University of Washington School of Medicine in Seattle. “It is absolutely consistent with what others are finding and with data I’ve seen from our own state.” “This paper made me very sad because of the backwards step we’re taking, in particular the documentation of this loss of life expectancy in Black and Latino communities in our country — it’s just heartbreaking. I think we can do better, but we need to pay attention, invest, and not be satisfied with the status quo,” says Dr. Morales.
Years of Progress Could Be Erased
On average, Black Americans have a shorter life expectancy than white Americans, and Hispanic people living in the United States have the longest life span of all three groups. About 76 out 100 Hispanic people will live until at least age 75, compared with about 70 white people and approximately 60 Black people, according to the National Vital Statistics Reports published in 2019. Historically, the life expectancy for Latinos at birth and at age 65 exceeds that of whites, and the impact of COVID-19 has been to reduce that difference significantly, says Morales. “We don’t want to go backwards,” he adds. For Black Americans, the life expectancy gap has been large for as long these statistics have been generated, though there had recently been some progress in narrowing the difference between white and Black communities, says Morales. “Now it’s going to open up again; years and years of progress are going to be erased in the course of one year,” he says.
COVID-19 Sheds New Light on a Preexisting Problem
The findings of this study are important, but much of what the paper reveals are issues we already know about, says Clarence Spigner, DrPH, MPH, a professor of health studies and an adjunct professor of global health in the department of global health at the University of Washington in Seattle. “COVID-19, as well as many determinants of health — genetic, environmental, lifestyle, service delivery — all have a disproportionate impact on populations made more at risk by structural and systemic racism,” Dr. Spigner says. The lesson was brought home in December, says Spigner, when a Black physician named Susan Moore posted a video to Facebook from the suburban Indianapolis hospital where she sought treatment for COVID-19. “Dr. Susan Moore came down with the virus and confronted racism from a white physician as she lay dying,” Spigner says. In the video, Moore described her doctor’s refusal to give her pain medication. “There remains the biological myth that Black patients have a higher tolerance for pain, along with the racist perception of drug addiction. Before dying from COVID-19, Moore posted a video of her treatment, or lack of it, due to medical racism,” says Spigner. There are many reasons, Morales says. “Working from home isn’t a common option in Latino communities,” he points out. He adds that lack of cash reserves, inadequate access to personal protective equipment (PPE), exposures at work, multigenerational households, lack of access to care, and lack of trust in government institutions due to past harms and ongoing threats of deportation could all be driving the higher rate of infection. “Not only are the infection rates higher, but the mortality rate among Latinos is higher in our state — close to three times higher — due to COVID-19 compared with non-Hispanic white people,” says Morales. Preexisting health conditions such as diabetes and obesity, along with the type of COVID-19 exposure, may be contributing to the higher rate of death in the Latino community, says Morales. “There is data to suggest that the higher the intensity of the exposure, the higher the risk for severe COVID-19. If you’re exposed for a long period of time to a high concentration of the virus in the air around you, you’re more likely to end up having a more severe infection,” he says. People in the Latino community may put off going to the doctor or hospital, and thus when they arrive to get care, they’re already sicker, which may hurt their chances of survival, says Morales. “There has been a lot written and discussed about the need for equitable access to the COVID-19 vaccine, but I’m concerned that’s not happening,” says Morales. While it is true that many states are prioritizing essential workers, that just means they are eligible to get the vaccine, but that doesn’t really help get vaccines into arms, he says. “It’s a very passive system — you have to seek the vaccine out, you have to know where to go,” Morales explains.
Vulnerable Groups Need to Be Prioritized for COVID-19 Vaccines
“There isn’t enough prioritization of vulnerable groups based on a higher risk of infection and death,” says Morales. In many states, age is the main criterion for vaccine eligibility. While there are vaccine awareness campaigns targeting Black and Latino communities, that isn’t enough, he believes. In many states, getting immunized for COVID-19 requires a certain level of health as well as computer literacy, a healthcare provider, registration through a portal, and English reading skills, says Morales. “I’m concerned we will see many of the same issues that we saw with COVID-19 testing, and it will create the same disparities,” he says. “If things are going to improve, we need to do a lot more investing in getting vaccines into high-risk communities.”
