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Edited by James W. Vaupel, University of Southern Denmark, Odense, Denmark, and approved December 8, 2020 (received for review July 15, 2020)
Significance
COVID-19 has generated a huge mortality toll in the United States, with a disproportionate number of deaths occurring among the Black and Latino populations. Measures of life expectancy quantify these disparities in an easily interpretable way. We project that COVID-19 will reduce US life expectancy in 2020 by 1.13 y. Estimated reductions for the Black and Latino populations are 3 to 4 times that for Whites. Consequently, COVID-19 is expected to reverse over 10 y of progress made in closing the Black−White gap in life expectancy and reduce the previous Latino mortality advantage by over 70%. Some reduction in life expectancy may persist beyond 2020 because of continued COVID-19 mortality and long-term health, social, and economic impacts of the pandemic.
Abstract
COVID-19 has resulted in a staggering death toll in the United States: over 215,000 by mid-October 2020, according to the Centers for Disease Control and Prevention. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 y for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths—one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our medium estimate indicates a reduction in US life expectancy at birth of 1.13 y to 77.48 y, lower than any year since 2003. We also project a 0.87-y reduction in life expectancy at age 65 y. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.10 and 3.05 y, respectively, both of which are several times the 0.68-y reduction for Whites. These projections imply an increase of nearly 40% in the Black−White life expectancy gap, from 3.6 y to over 5 y, thereby eliminating progress made in reducing this differential since 2006. Latinos, who have consistently experienced lower mortality than Whites (a phenomenon known as the Latino or Hispanic paradox), would see their more than 3-y survival advantage reduced to less than 1 y.
The number of deaths from COVID-19 in the United States is staggering: As of mid-October 2020, more than 215,000 COVID-19 deaths had occurred, and over 100,000 additional deaths were projected by the end of year (1, 2). An important but as of yet unanswered question concerns the impact of this exceptional number of deaths on life expectancy for the entire nation as well as the consequences for marginalized groups. Despite concerns about inadequate testing and unreliable data, there is convincing evidence that Black and Latino Americans experience a disproportionate burden of COVID-19 morbidity and mortality.* Of the deaths for which race and ethnicity have been reported to the National Center for Health Statistics (NCHS), 21% were Black and 22% were Latino (3).† A plethora of factors likely contribute to these disparities, many of which reflect enduring structural inequalities for the Black and Latino populations that increase both risk of exposure to COVID-19 and risk of death for those infected. Taken together, the high death toll and the racial and ethnic inequities in COVID-19 mortality suggest that COVID-19 will have a major impact on 2020 life expectancy, especially for the Black and Latino populations.
Life expectancy, a frequently used metric of population health that is typically measured as of birth, is an informative tool for examining the differential impact of COVID-19 on survival, as it is unaffected by the age distribution of the underlying populations.‡ In contrast, for example, comparisons of overall (crude) death rates or proportions of deaths by race and ethnicity are biased by the fact that the Black and Latino populations in the United States are younger than the White population and, all else being equal, would have fewer deaths (4, 5).
In the period preceding the COVID-19 pandemic, annual improvements in US life expectancy had been small—for example, an increase from 76.8 y to 78.9 y or an average annual increase of 0.15 y between 2000 and 2014—but overall life expectancy has rarely declined (6).§ The recent declines that have taken place have attracted enormous attention from researchers and the media. Annual reductions of 0.1 y for each of three consecutive years (2015, 2016, and 2017) (7⇓–9), attributed partly to increases in “deaths of despair” (6), made repeated headlines as the longest period of decrease since the 1918 influenza pandemic. Conversely, a 0.1-y recovery in life expectancy in 2018 was greeted with substantial relief (10).
Black Americans have consistently had lower life expectancy than Whites, but relative gains in life expectancy over the past two decades have been greater in the Black population than among Whites, thereby narrowing the Black mortality disadvantage (11, 12). In contrast, because Latinos have consistently had higher life expectancy than Whites, a phenomenon referred to as the Latino or Hispanic epidemiological paradox, larger improvements in life expectancy in the Latino population widened the gap between Whites and Latinos in recent years, further increasing the Latino mortality advantage (13).
The COVID-19 pandemic has the potential to bring about a greater decline in annual life expectancy than the United States has experienced in many years, perhaps since the 1918 influenza pandemic, which is estimated to have reduced US life expectancy between 7 and 12 y (14).¶ However, the concentration of COVID-19 deaths among the elderly, in contrast to the preponderance of young adult deaths in the previous influenza pandemic (15), may reduce the impact of COVID-19 on life expectancy at birth. The exceptionally high COVID-19 death rates borne by Black and Latino individuals are likely to bring about larger reductions in life expectancy for these populations than for Whites, but the pressing question is by how much. In the present analysis, we address this issue by using ongoing data collection of COVID-19 deaths and projections of future deaths under different policy scenarios to estimate how COVID-19 mortality will affect life expectancy at birth and at age 65 y for the total population as well as separately by race and ethnicity. We also assess the implications of these projections for the Black disadvantage and the Latino advantage relative to Whites.
Results
We present estimated life expectancy values under four projection scenarios in Table 1. These include one in which the COVID-19 pandemic had not occurred and three projections for the cumulative number of COVID-19 deaths through December 31, 2020 produced by the Institute for Health Metrics and Evaluation (IHME): 1) ∼321,000 deaths under the current projection scenario, which is the medium scenario issued by IHME; 2) ∼348,000 deaths under a higher mortality scenario assuming continued easing of mandates; and 3) ∼276,000 deaths under a lower mortality scenario assuming universal mask usage in the population (1). We estimate that US life expectancy at birth would have been 78.61 y in 2020 had the COVID-19 pandemic not occurred, but all three mortality scenarios imply huge reductions in life expectancy at birth for the United States in 2020. The medium scenario would bring about a decline of 1.13 y, whereas the higher and lower mortality scenarios project declines of 1.22 and 0.98 y, respectively. Life expectancy at age 65 y, which is estimated to have been 19.40 y in the absence of COVID-19, is projected to decline by 0.87 y under the medium scenario, 0.94 y under the higher mortality scenario, and 0.75 y under the lower mortality scenario.
Life expectancy projections for the United States in 2020 by race and ethnicity under different COVID-19 mortality scenarios
Estimated life expectancy values in the absence of COVID-19 compared with those under the medium scenario are displayed in Fig. 1, which underscores the much larger reductions in life expectancy anticipated for the Black and Latino populations than for Whites or the total United States. Under the medium scenario, White life expectancy is projected to decline by 0.68 y, while the corresponding declines for Black and Latino life expectancies are 2.10 and 3.05 y, respectively. We also observe racial and ethnic disparities in the projected impact of COVID-19 on remaining life expectancy at age 65 y, which is estimated to decline by 0.63 y for the White population, 1.73 y for the Black population, and 2.24 y for the Latino population.
Life expectancy projections for 2020 by race and ethnicity in the absence of COVID-19 and under the medium scenario. The COVID-19 medium scenario is based on the IHME current projection scenario (October 9, 2020 update).
For Whites, the projected effect of COVID-19 is similar for life expectancy at birth and at age 65 y; however, for the Black and Latino populations, the effect on life expectancy at birth is notably larger than for life expectancy at age 65 y, reflecting the higher burden of COVID-19 mortality at younger ages among these groups. These racial and ethnic differences are also revealed by identifying the age groups showing the largest proportional increases in mortality rates in the presence of COVID-19: 75 y to 85 y and 85 y and over in the White population, 65 y to 75 y and 75 y to 85 y in the Black population, and 55 y to 65 y and 65 y to 75 y in the Latino population (SI Appendix).
Notable racial and ethnic disparities in life expectancy declines are projected under both of the alternative COVID-19 mortality scenarios. Under the higher mortality scenario, life expectancy is projected to be 0.73 y lower for the White population, 2.26 y lower for the Black population, and 3.28 y lower for the Latino population. Under the lower mortality scenario, life expectancy at birth is projected to decline by 0.59 y for the White population, 1.83 y for the Black population, and 2.66 y for the Latino population.
To put these projected life expectancy declines in perspective, trends in life expectancy at birth from 1980 to 2020 are presented in Fig. 2 by race and ethnicity. The projected decline in life expectancy due to COVID-19 for the United States, under the medium scenario, is larger than any other single-year decline during this time period and would return US life expectancy to a value (77.48 y) lower than that observed in any year since 2003.
Trends in life expectancy at birth by race and ethnicity: 1980–2020. Note that the data for the Black and White populations prior to 2006 include Latinos; data for these groups from 2006 onward are for the non-Latino Black and non-Latino White populations. The projections for 2020 are based on the IHME current projection scenario (October 9, 2020 update).
To illustrate the effect of COVID-19 on the racial and ethnic differences in life expectancy at birth, Fig. 3 displays the difference in life expectancy for the Black and Latino populations relative to the White population. Following a widening in the late 1980s, the Black−White life expectancy gap has narrowed from 7.1 y in 1993 to 3.6 y in 2017. Under the medium scenario, this Black disadvantage is projected to widen to 5.06 y in 2020, which is the size of the gap in 2006. In contrast, since 2006 (the earliest year for which Latinos are separately identified in Vital Statistics), the Latino population has experienced a growing life expectancy advantage relative to Whites, increasing from an advantage of 2.1 y in 2006 to 3.3 y in 2017. Under the medium scenario, this advantage is estimated to decline to 0.93 y in 2020, smaller than ever recorded nationally. The Black−White gap would widen to 5.17 y under the higher mortality scenario and 4.88 y under the lower mortality scenario. The Latino advantage would narrow to 0.75 y under the higher mortality scenario and 1.23 y under the lower mortality scenario (see Table 1 for projected life expectancy values under alternative scenarios).
Trends in racial and ethnic differences in life expectancy at birth: 1980–2020. Note that the data for the Black and White populations prior to 2006 include Latinos; data for these groups from 2006 onward are for the non-Latino Black and non-Latino White populations. The projections for 2020 are based on the IHME current projection scenario (October 9, 2020 update).
Discussion
Our findings reveal that, according to the medium scenario of COVID-19 mortality, the pandemic is projected to result in an enormous decline in 2020 US period life expectancy of 1.13 y. This estimate is similar to that calculated by Heuveline and Tzen (16) in August 2020. This impact is about 10 times as large as the worrisome annual decreases several years ago that were attributed largely to drug overdoses, other external causes, and respiratory and cardiovascular diseases (6, 17). The US reduction in 2020 life expectancy is projected to exceed that of most other high-income countries (16), indicating that the United States—which already had a life expectancy below that of all other high-income developed nations prior to the pandemic (17)—will see its life expectancy fall even farther behind its peers. Although the majority of COVID-19 deaths in 2020 have likely already occurred, our projections under different mortality scenarios underscore the potential for policy interventions and public behavior to either mitigate or exacerbate the ultimate effect of COVID-19 on 2020 life expectancy. In particular, estimated declines in life expectancy for all racial and ethnic groups under the lower mortality universal mask scenario are reduced by over 12%, in contrast to an increase of over 7% under the higher mortality scenario that assumes continued easing of mandates.
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