Life Expectancy in the Covid Era

N ew life-expectancy estimates are out for 2021, and they paint a grim picture: Life expectancy declined in 2021 by 0.9 years to 76.1 years, the lowest it has been since 1996. This followed a decline in 2020 leading to an overall decrease in life expectancy between 2019 and 2021 of 2.7 years for the total population. Covid-19 was responsible for 50 percent of the 2021 longevity decline. A grab bag of other causes of death was responsible for the balance with unintentional injuries being the most common (16 percent).

But closer examination of the tables from the CDC’s National Center for Health Statistics reveals an interesting fact. While Hispanics and blacks both had substantially greater life expectancy losses than whites during 2020, in 2021 the situation was reversed. The white population saw a one-year decline in life expectancy while blacks saw a 0.7 year drop and Hispanics saw a 0.2 year drop.

Many public-health experts and media pundits blamed the disproportionate losses suffered by people of color in 2020 on “structural inequalities” and “systemic racism.” Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, for example, wrote that the foremost cause of “disproportionate reductions in life expectancy among racial and ethnic groups in the US” in 2020 was “systemic racism.” Now these experts are scrambling to explain what happened in 2021.

The New York Times quotes Woolf as saying that the worse 2021 outcomes for whites “reflects the greater efforts by Black [sic] and Hispanics to get vaccinated, to wear masks and take other measures to protect themselves, and the greater tendency in white populations to push back on those behaviors.”

Put these lines of reasoning together and the relatively worse outcomes for people of color in 2020 was whites’ fault (systemic racism) and whites’ relatively worse outcomes in 2021 was their fault too (intransigence and failure to “follow the science”).

Yet this explanation makes little sense. If blacks and Hispanics had a greater tendency to take protective measures, that was true during 2020 as well as 2021. The major difference between the years is that vaccines became available in 2021. Everything else, including the alleged systemic racism, remained the same.

Greater receptivity to vaccination does not explain the lower decreases in longevity for populations of color as compared to whites during 2021. For the entire time that vaccines have been widely available — from spring 2021 to the present — roughly 5 percentage points fewer of the black population have received at least one vaccine dose than of the white population. Hispanic vaccination rates also trailed white vaccination rates throughout 2021. And fewer blacks (45 percent) and Hispanics (42 percent) than whites (56 percent) who were eligible for boosters got the additional shots.

Minority communities initially suffered greater deaths due to three factors: employment (black workers were only two-thirds and Hispanic workers about one half as likely as white workers to be able to work from home); worse baseline health (27 percent of non-elderly black adults, ages 18 to 64, have underlying medical conditions that complicate Covid-19, compared with 21 percent of whites and 20 percent of Hispanics); and where black people live (blacks are a higher percentage of the population in the areas where Covid-19 initially hit). When weighted to reflect where Covid-19 outbreaks occurred through 2020, blacks represented 16.0 percent of the population as compared to their unweighted 12.6 percent of the population.

Arguably, the first two of these three factors could be due in part to “systemic” or “structural inequalities.” But the third, where Covid was prevalent during the early months of the pandemic, could not.

Moreover, neither the types of jobs nor the underlying comorbidities of minority groups changed between 2020 and 2021. What changed was the geographic distribution of the virus. It moved beyond the initial concentration in urban areas and the Northeast into the rest of the country where whites were a bigger percentage of the population.

The lower 2021 decline in life expectancy in people of color relative to whites primarily reflects this geographic spread. Between 2020 and 2021 the geographically weighted population distribution of where Covid occurred fell from 16.0 to 13.4 percent for blacks and from 18 to 15.9 percent for Hispanics. In contrast, the weighted percentage for whites rose from 60.4 to 65.8, even though whites comprise just 59.7 percent of the total population.

The relaxation of lockdowns in 2021 versus 2020 was also likely important.  This would have eased the racial divide over who could work remotely and who had to have riskier, in-person contact.

The reality is that the pandemic has been a medical and economic disaster for all Americans. It ended and reversed years of progress in narrowing the life expectancy gap between whites and blacks. It decreased the life-expectancy advantage that Hispanics had over whites — life expectancy was 3.1 years longer for Hispanics than whites in 2019, decreasing to 1.3 years longer in 2021. Asian Americans who have long had the best life expectancy saw a 2.1 year decrease between 2019 and 2021. Whites suffered a 2.4 year decline. And for the group that already had the worst life expectancy pre-pandemic — American Indians and Alaskan Natives — life expectancy fell a staggering 6.6 years between 2019 and 2021 from 71.8 to 65.2 years.

The experience of 2021 versus 2020 shows that attaching so much importance to “social justice” considerations to explain every issue, including the nature of Covid-19’s consequences, is neither accurate nor helpful. It divides rather than elucidates.