Association of the COVID-19 Pandemic With Estimated Life Expectancy by Race/Ethnicity in the United States, 2020

In October 2020, we estimated the impact of COVID-19 on 2020 period life expectancy at birth in the US by race/ethnicity using observed COVID-19 deaths from February 1, 2020, to October 3, 2020, and projected COVID-19 deaths through the remainder of 2020 under 3 scenarios (low, medium, and high COVID-19 mortality).¹ Under the medium scenario, we projected a decline in 2020 US life expectancy of 1.13 years for the total population, 0.68 years for the White population, 2.10 years for the Black population, and 3.05 years for the Latino population.¹ This study updates these estimates with observed deaths for all of 2020 and more recent prepandemic mortality conditions.

This cross-sectional study uses publicly available data and was exempt from institutional review board approval and informed consent, per the institutional review board of Princeton University. This study follows Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies; the supplementary material provides additional details.

This cross-sectional study uses provisional COVID-19 death counts by week, race/ethnicity, and age from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS); 2019 mid-year population estimates by race/ethnicity and age from the US Census Bureau; and 2018 US life tables by race/ethnicity from the US Vital Statistics System. We treat 2018 life tables as counterfactuals to 2020 life tables in which COVID-19 has been eliminated and estimate 2020 life expectancy including COVID-19 mortality (eMethods in the Supplement). Race/ethnicity was included to estimate disparities in life expectancy reductions. In census data, race/ethnicity is self-reported; in the mortality data, race/ethnicity is typically recorded by funeral directors with information from the decedent’s next of kin. To estimate life expectancy reductions in 2021 thus far, we repeat these calculations using provisional deaths through early April 2021. Because we include all reported COVID-19 deaths, we do not test for significant differences.

The calculations of life expectancy include 380 868 COVID-19 deaths in 2020. Race/ethnicity data were available for more than 99% of these deaths, including 230 016 among non-Latino White individuals, 60 405 among non-Latino Black individuals, and 69 066 among Latino individuals. Updated estimates indicate that COVID-19 reduced overall 2020 US life expectancy by 1.31 years, from 78.74 years to 77.43 years (Table and Figure). The reductions are 3.2 times as large for the Latino population (3.03 years) and twice as large for the Black population (1.90 years) compared with the White population (0.94 years).

This cross-sectional study found that changes in life expectancy associated with COVID-19 for the total US and White populations exceeded those previously estimated.¹ The change in life expectancy among the Black population was smaller than projected but remained much larger than that for the White population. The differences are likely partly due to the changing geography of the outbreak: since our October projections, Midwestern and Mountain states with large White populations experienced surges in COVID-19 cases and deaths. A minor change in estimates resulted from using 2018 rather than 2017 for the absent COVID-19 scenario.

Despite a prepandemic 7-year advantage in life expectancy compared with the Black population and 3-year advantage compared with the White population, along with lower rates of smoking and most chronic conditions,² the Latino population had the largest life expectancy decline associated with COVID-19. This unprecedented change likely stems from social and economic inequities that are associated with both higher exposure to infection and higher fatality among those infected. Compared with Black and White individuals, Latino individuals in the US have lower rates of health insurance (affecting access to testing, treatment, and quality health care),^2,3 are more apt to live in multigenerational and crowded households,^3,4 and are more likely to hold frontline jobs involving risks of viral transmission without adequate protection.^3,5 Language barriers may prevent Latino individuals from receiving timely, comprehensible, and accurate information regarding COVID-19 or effective strategies to protect themselves.^3,4 High poverty rates and low status jobs offer Latino individuals few avenues for reducing viral exposure in the absence of government programs.^3,5

A limitation of this study is that these life expectancy reductions are almost certainly underestimated because they exclude misclassified COVID-19 deaths and mortality from causes resulting indirectly from COVID-19. Recent estimates suggest that such underestimates may be especially large for the Black population⁶ and thus likely affect racial disparities in life expectancy.

The findings of this cross-sectional study suggest that, consistent with our earlier speculation,¹ COVID-19 is associated with continued reductions in life expectancy in 2021 compared with prepandemic levels. COVID-19 deaths through early April 2021 already indicate an almost 0.6-year reduction in overall 2021 US life expectancy with continued disproportionate changes for the Black and Latino populations.

Accepted for Publication: April 18, 2021.

Published: June 24, 2021. doi:10.1001/jamanetworkopen.2021.14520

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Andrasfay T et al. JAMA Network Open.

Corresponding Author: Theresa Andrasfay, PhD, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave, Los Angeles, CA 90089 (andrasfa@usc.edu).

Author Contributions: Dr Andrasfay had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Both authors.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by the National Institute on Aging (grant No. T32AG000037).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.