U.S. Life Expectancy Declined Nearly a Year in 2021, Deepening Historic Slide

Americans’ life expectancy continued to slide in 2021. According to provisional data from the National Center for Health Statistics released on Aug. 31, life expectancy dropped by 0.9 years in 2021, leading to a total decrease of about 2.7 years between 2019 and 2021—the largest two-year decline in a century.

Once again, COVID-19 was the primary reason Americans died younger, accounting for 50% of the decline. However, other causes of death—including drug overdoses, heart disease, and liver disease—also surged, hinting at the devastating ripple effects the pandemic has had on society.

The life expectancy for someone born in 2021 was 76.1 years, down from 77 years in 2020. The decline was greater for men than for women; the life expectancy for males was 73.2 years, down an entire year from 2020, and 79.1 for females, a 0.8 year loss.
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The drop in life expectancy wasn’t inevitable, especially after a highly effective COVID-19 vaccine became available, says Andrew Stokes, an assistant professor in the department of global health at Boston University School of Public Health. In fact, many wealthy countries—including much of western Europe—recovered in 2021 after experiencing declines in life expectancy in 2020—while some countries, like Australia, experienced no declines at all. “The U.S. is an outlier,” says Stokes. “In a highly functioning public health and health care system, one would expect rebounds due to widespread access to vaccines.”

Without COVID-19 vaccinations, life expectancy could have dropped even further. About 1.1 million more people in the U.S. likely would have died from COVID-19 between Dec. 12, 2020 and Nov. 21, 2021, according to a Commonwealth Fund estimate. The virus also indirectly increased risk factors for other conditions, including by disrupting the health care system and people’s lives.

In particular, researchers have warned that the pandemic put people at greater risk of dying from cardiovascular disease. COVID-19 has strained the U.S. health care system, leading to widespread understaffing, while patients delayed both routine doctors’ visits and trips to the hospital. More directly, SARS-CoV-2 infection can damage the heart, and is thought to have raised patients’ risk of dying.

Substances like alcohol and drugs also posed a major health threat during the pandemic. Drug overdose deaths increased sharply, rising 15% to an estimated 107,622 deaths from 2020 to 2021, especially among Black, American Indian, and Alaska Native people. The increasing prevalence of illicit fentanyl, a highly potent synthetic opioid that was involved in about 66% of overdose deaths, is thought to be a major contributing factor. Researchers believe that the pandemic made substance use riskier by adding to isolation and worsening mental health, as well as disrupting patients’ access to treatment programs and health care. Among American Indians and Alaska Natives, chronic liver disease and cirrhosis—both of which can result from alcohol use—contributed to 18.6% of the decline in life expectancy.

Black people, Hispanics, and native peoples experienced the greatest total declines in life expectancy from 2019 to 2021. The worst decline during both years was among American Indian and Alaska Natives: 1.9 years from 2020 to 2021, leading to a total decline of 6.6 years since 2019.

However, in 2021, white people also saw a significant drop in life expectancy: one year. That’s compared to Black people (0.7 of a year) and Hispanics (0.1 of a year). This isn’t because conditions improved for Black and Hispanic communities, Stokes emphasizes; rather, it was because more white people died. COVID-19 caused 54.1% of the decline in white life expectancy. For the most part, says Stokes, this is because the Delta wave killed younger people and affected more rural areas—places with weaker health care systems, lower vaccination rates, and more white people, although the average age at death shifted older among white people during the Omicron wave.

“I think it’s fair to say that at least part of the [U.S.’s] poor performance is due to the lackluster health care response and lack of uptake of vaccines,” says Stokes. “Things could have been different if we had had a more rigorous public health response.”