The Lancet: Disparities in life expectancy persist among racial and ethnic groups across the USA

• New study offers the first comprehensive, county-level life expectancy estimates in the USA and highlights important differences among racial and ethnic groups.
• The analysis reveals that despite overall life expectancy gains of 2.3 years (from 76.8 years in 2000 to 79.1 years in 2019) during the 20-year study period (2000-2019), disparities among racial and ethnic groups remain, with Black populations still experiencing shorter life expectancy than White populations.
• Life expectancy among the American Indian/Alaska Native population did not improve during the study period.
• During the last 10 years of the study (2010-2019), life expectancy growth was stagnant across all races and ethnicities, setting the stage for declines in life expectancy that have been reported since the COVID-19 pandemic.

Overall life expectancy in the USA increased by 2.3 years from 76.8 years in 2000 to 79.1 years in 2019, but disparities among the racial and ethnic groups remain widespread and persistent, according to a new study published in The Lancet. The study marks the first county-level analysis of life expectancy in the USA over an extended time period that includes estimates for the American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (API) populations as well as Black, Latino, and White populations.

In contrast to similar studies, researchers are offering county, state, and federal health leaders a unique, granular view of life expectancy spanning two decades, which suggests that among five racial and ethnic groups, improvements in life expectancy were more widespread across counties and generally larger from 2000–2010 compared to 2010–2019. However, life expectancy nationally remained stagnant in the USA over the past 10 years. Moreover, these findings are prior to COVID-19 and suggest that the pandemic came on top of cracks in the US health system and continued disparities that need to be addressed.

Using de-identified death records from the US Centers for Disease Control and Prevention’s National Vital Statistics System (NVSS) and population estimates from the National Center for Health Statistics (NCHS), researchers looked at life expectancy at birth by year, county, and racial and ethnic group from 2000 to 2019 across 3,110 counties in the USA. At the national level and in most counties, life expectancy increased more for the Black population (+3.9 years) than any other racial and ethnic group, including a small number of counties where the life expectancy of Black populations exceeded their White counterparts during the study period. However, researchers also noted that significant disparities in life expectancy remain between Black and White populations. API and Latino populations had the highest life expectancy, while American Indian and Alaska Native (AIAN) populations had the lowest.

The latest findings also suggest that although life expectancy increased in 3,079 counties (97.4%) in the first 10 years, it declined in more than half of counties (59.9%) in the last 10 years. From 2010 to 2019, API (0.8 years increase), Latino (0.3 years increase), Black (0.5 years increase), and White (0.1 years) populations only experienced small improvements in life expectancy. Over the entire period, life expectancy among AIAN populations remained the same. Life expectancy also varied widely among counties in all years. For example, in 2019, it ranged from as low as 64.5 years to as high as 91.7 years.

“Gains in life expectancy are noteworthy but stop short of suggesting we’re closing the gap that persists among different racial and ethnic groups. These disparities set the stage for further inequities the USA recorded among different racial and ethnic groups when the COVID-19 pandemic hit in 2020. The USA logged more COVID-19 cases, hospitalizations, and deaths in those communities compared to White populations,” says Dr Ali Mokdad, senior author from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. [1]

Despite narrowing gaps, life expectancy for Black populations remained lower than White populations

Between 2000 and 2019, life expectancy increased more for Black populations than any other racial and ethnic group, increasing by 3.9 years from 71.4 years in 2000 to 75.3 years in 2019. However, life expectancy remained lower among Black populations compared to White populations in 1,287 counties among 1,480 counties where there was sufficient population to produce reliable estimates in 2019, and differences ranged from -15.5 years to 7.9 years.

At the same time, the increase in life expectancy for the White population was more moderate, with an overall increase of 1.7 years between 2000-2019, from 77.3 years to 78.9 years. However, between 2010 and 2019, life expectancy for White populations only increased by 0.1 years.

“These varied outcomes in life expectancy raise significant questions. Why is life expectancy worse for some and better for others? The novel details in this study provide us the opportunity to evaluate the impact of social and structural determinants on health outcomes in unprecedented ways. This in turn allows us to better identify responsive and enduring interventions for local communities,” says Dr Eliseo J. Pérez-Stable, co-author and director of the US National Institute on Minority Health and Health Disparities (NIMHD). [1] 

Gains for API and Latino populations but alarming trends for AIAN populations compared to other groups

API populations (+2.9 years from 82.8 years in 2000 to 85.7 years in 2019) and Latino populations (+2.7 years from 79.5 years in 2000 to 82.2 years in 2019) experienced larger than average increases in life expectancy and the highest life expectancy nationally and across most counties throughout the analysis period.

However, life expectancy for (AIAN) indicated an alarming trend. Even in the context of stagnating trends for White populations, the already large gap between the AIAN and White populations grew from 2000 to 2019, both nationally and in most counties, from 4.1 to 5.8 (+1.7 years). In fact, in 2019, life expectancy among the AIAN population (73.1 years) was 12.5 years lower than among the API population (85.7 years).

Improved reporting systems are urgently needed to identify and address disparities

The study’s results highlight considerable variation in life expectancy among racial and ethnic groups, locations, and over time, exposing both positive and negative trends. The life expectancy disparities reported in this study underscore the pressing need for local-level, detailed data to support targeted efforts to address and eliminate racial and ethnic health disparities and their root causes.

“The pandemic exposed stressors and weaknesses in local and national systems that continuously put our most vulnerable populations at risk. These findings offer county, state, and federal leaders a unique look at the pervasiveness of health disparities in their respective communities,” says study author Dr Laura Dwyer-Lindgren of IHME. “It’s a call for direct action in the form of meaningful policy changes to address systemic issues and to help all people living in the USA live longer, healthier lives.” [1]

The authors note several study limitations. This study analyzed race and ethnicity in five groups, with only the primary race being assessed: AIAN, API, Black, Latino, and White. Given the variability of population size among racial and ethnic groups and counties, and the need to correct for misclassification of racial and ethnic groups on death certificates, estimate uncertainty intervals varied by racial and ethnic groups and also by rural and urban status, with data on White populations and on urban areas having the highest degree of certainty. This underscores the need for more robust data and more accurate collection of race and ethnicity data. Finally, life expectancy estimates presented here are for the population living in a county at a particular time, and should be interpreted as such, particularly for counties with dynamic populations due to in- or out-migration, the presence of large colleges and universities, or the presence of correctional facilities.

The authors call for future studies and applaud ongoing research addressing disparities in life expectancy and inequities in social determinants of health.

NOTES TO EDITORS

This study was funded by the US National Institutes of Health. A full list of the US Health Disparities Collaborators involved in the study is available at the end of the manuscript.

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[1] Quote direct from author and cannot be found in the text of the Article.

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