Life expectancy disparities in the U.S. have widened significantly, with American Indian and Alaska Native participants in the West experiencing a decline to just 63.6 years by 2021, according to a recent analysis examining trends from January 1, 2000, to December 31, 2021.
The analysis of life expectancy trends highlights disparities across ten U.S. population groups defined by race, ethnicity, geography, and socioeconomic factors. Researchers expanded on the 2006 Eight Americas framework by adding two Latino population groups and analyzing data adjusted for misreporting of race and ethnicity on death certificates.
In 2000, life expectancy ranged from 70.5 years among Black participants in non-metropolitan, low-income Southern counties ("America 9") to 83.1 years among Asian Americans ("America 1"), representing a 12.6-year gap. By 2021, this gap increased to 20.4 years, with American Indian and Alaska Native (AIAN) participants in the West ("America 10") experiencing the largest decline in life expectancy, reaching 63.6 years. Notably, AIAN participants were the only group to experience substantial declines in life expectancy from 2000-2019, even before the pandemic.
The COVID-19 pandemic accelerated these declines, with AIAN participants losing 5.3 years between 2019 and 2020. Both Latino groups faced similar declines of 3.9 years during the same period. While the three Black Americas saw the largest improvements from 2000 to 2010, progress stagnated in the following decade. By 2021, only three groups showed partial rebounds: Asian Americans, Latino Americans in non-Southwest regions, and Black Americans in highly segregated metropolitan areas.
The researchers found that disparities in life expectancy across these groups grew from 12.6 years in 2000 to 20.4 years in 2021. They attributed much of this trend to the disproportionate impact of the COVID-19 pandemic on AIAN, Black, and Latino populations. Gains made earlier in the study period, particularly among Black Americans, were reversed in subsequent years, erasing previous progress.
Published in The Lancet, the analysis identifies systemic inequities—including income inequality, educational disparities, and limited healthcare access—as primary contributors to these trends. Researchers noted that differences in income and educational attainment alone don't fully explain the patterns in life expectancy. For instance, "America 8," representing White individuals in low-income Appalachian regions, experienced stagnation in life expectancy before the pandemic and sharp declines afterward. By contrast, Latino groups ("Americas 2 and 5") made pre-pandemic gains despite lower income and educational attainment, though these advantages diminished during the pandemic.
Researchers emphasize the importance of targeted public health interventions to address the structural factors driving these disparities. They highlight the need for equitable healthcare access, enhanced education, and socioeconomic reforms, particularly for AIAN populations and low-income rural communities. Without systemic change, they caution, the longevity gap will likely persist, with substantial implications for public health.
Full disclosures can be found in the published analysis.