Never before has the U.S. recorded such an immense increase in the rate of people dying. Not during the Spanish flu. Not during either of the great wars. Not during the worst years of AIDS or the opioid crisis.
In 2020, the death rate in the United States rose 16.8 per cent, as the pandemic carved 1.8 years from life expectancy, widening the gap with other developed countries and intensifying questions about systemic failings in the world’s richest country.
“It’s the largest percentage increase that we’ve seen since 1900,” the year those records began to be kept, said Robert Anderson, chief of the mortality statistics branch of the National Center for Health Statistics, in an interview. Final data for 2020 were released Wednesday. “Nineteen eighteen, obviously, was a very bad year,” he said. “But the rate only went up by about 12 per cent.”
The U.S. recorded nearly 529,000 more deaths in 2020 than the previous year, as COVID-19 leapt to the third leading cause of death, after heart disease and cancer. The U.S. has not seen a decrease in life expectancy this large since 1943, the deadliest year in the Second World War.
The statistics reflect the toll of the pandemic’s first year, before vaccines were widely available and amid early struggles to identify and contain the novel coronavirus.
But they also present a stark assessment of the COVID-19 response in a country where some of the best medical resources on Earth have not succeeded in resolving profound inequities in public health.
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Before COVID-19, U.S. life expectancy had fallen nearly two years behind the average of other wealthy countries. From 2018 to 2020, the gap grew to 4.69 years, Steven Woolf, a leading U.S. scholar of population health and health equity, found in research published this year.
“The loss of life in the U.S. has been massive,” said Prof. Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. In Canada, by comparison, life expectancy fell by about five months, Statistics Canada has estimated.
“The reason other countries are doing better is they’re making different policy choices,” said Prof. Woolf, who chaired a National Academy of Sciences committee that produced a 2013 report entitled Shorter Lives, Poorer Health.
When it comes to politics and well-being, “it’s one thing if it’s a debate over tax policy. But in a situation like this, it’s life or death,” he said. “And we’re seeing the results.”
The reasons extend beyond the heavier pandemic toll on conservative jurisdictions in the U.S., with their greater hostility toward masks and vaccinations. The pandemic, which has curbed life expectancy among Black Americans nearly three times more than among whites, has also given deadly new shape to long-standing problems.
“The factors that are really driving our health are socioeconomic conditions, education, income, job security and also our environment – the neighbourhoods that we live in, the physical and social environmental factors that affect our health,” Prof. Woolf said.
The calculation of life expectancy at birth is often misunderstood. It does not describe how many years a baby born today should expect to live, since it is impossible to forecast future events that might affect health. Rather, it shows how long someone born today could expect to live if they experienced current conditions at every stage in life.
That makes it a particularly revealing measure of a country’s well-being at a given moment. In 2020, U.S. life expectancy stood at 77 years, compared with 81.7 years in Canada.
While the increase in the U.S. death rate last year was historically significant, the overall death rate remains roughly a quarter what it was in the early 1900s. Last year’s fall in life expectancy has, however, brought the U.S. back to levels not seen for nearly two decades.
Researchers tracking U.S. life expectancy began to raise alarms seven years ago, when numbers began to edge downward as opioid deaths mounted. But those changes have not affected all people equally. Between 2010 and 2017, life expectancy at age 25 increased among the highly educated. College-educated black women, for example, saw a 1.7 year rise.
Those with a high-school degree or less, however, saw declines: one year for white men and women, several months for Black men.
The pandemic has worsened inequities in income, savings and rates of infection. “I can almost assure you we’re seeing a vast widening of life-expectancy differences between well-educated and less-educated Americans” as well, said Mark Hayward, a scholar with the University of Texas at Austin and president-elect of the Interdisciplinary Association for Population Health Science. He was one of the authors of the earlier report.
“We’re really talking about a cluster of risks that go along with social advantage.”
In Canada, too, pandemic infection and death rates have been higher among lower-income and non-white communities. “And I would expect that we’d also see similar variation in measures like life expectancy,” said Patrick Denice, a sociologist at the University of Western Ontario.
Changes in life expectancy, he said, are in some ways “capturing the hardship and the amount of loss that we’ve experienced.”
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