Reductions in US life expectancy during the COVID-19 pandemic by race and ethnicity: Is 2021 a repetition of 2020?

Prevention Science and Health Equity: A Comprehensive Framework for Preventing Health Inequities and Disparities Associated with Race, Ethnicity, and Social Class

The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions-especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life.

Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality

The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.

Life Expectancy Loss among Native Americans During the COVID-19 Pandemic

BACKGROUND

There has been little systematic research on the mortality impact of COVID-19 in the Native American population.

OBJECTIVE

We provide estimates of loss of life expectancy in 2020 and 2021 for the Native American population.

METHODS

We use data on age-specific all-cause mortality rates from CDC WONDER and the 2019 life table recently released by the National Vital Statistics System for Native Americans to calculate life tables for the Native American population in 2020 and 2021 and obtain estimates of life expectancy reductions during the COVID-19 pandemic.

RESULTS

The pandemic has set Native Americans further behind other major racial/ethnic groups in terms of life expectancy: the estimated loss in life expectancy at birth for Native Americans is 4.5 years in 2020 and 6.4 years in 2021.

CONCLUSIONS

These results underscore the disproportionate share of deaths experienced by Native Americans: a loss in life expectancy at birth in 2020 that is more than three years larger than that for Whites and about 1.5 years greater than the losses for the Black and Latino populations. Despite a successful vaccination campaign among Native Americans, the estimated loss in life expectancy at birth in 2021 unexpectedly exceeds that in 2020. Contribution: The increased loss in life expectancy in 2021, despite higher vaccination rates than in other racial/ethnic groups, highlights the huge challenges faced by Native Americans in their efforts to control the deleterious consequences of the pandemic.

COVID-19 is not an Independent Cause of Death

The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll researchers have estimated declines in 2020 life expectancy at birth. Because data are often available only for COVID-19 deaths, the risks of dying from COVID-19 are assumed to be independent of those from other causes. We explore the soundness of this assumption based on data from the US and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods. One estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence. The other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (US) of the decline in e ₀ , depending on how the number of other reported causes of death changed in 2020.

Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany

Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population's elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015-2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men's and women's RLE. Men's district-level RLE ranged between 19.89 and 24.32 years, women's district-level RLE between 23.67 and 27.16 years. The best single predictor both for men's and women's RLE at district level was 'proportion of employees with academic degree' with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as 'household income' (men), 'proportion of elder with financial elder support' (women), and 'unemployment' (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population's educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.

Life expectancy loss among Native Americans during the COVID-19 pandemic

BACKGROUND

There has been little systematic research on the mortality impact of COVID-19 in the Native American population.

OBJECTIVE

We provide estimates of loss of life expectancy in 2020 and 2021 relative to 2019 for the Native American population.

METHODS

We use data on age-specific all-cause mortality rates from CDC WONDER and the 2019 life table recently released by the National Vital Statistics System for Native Americans to calculate life tables for the Native American population in 2020 and 2021 and to obtain estimates of life expectancy reductions during the COVID-19 pandemic.

RESULTS

The pandemic has set Native Americans further behind other major racial/ethnic groups in terms of life expectancy. The estimated loss in life expectancy at birth for Native Americans is 4.5 years in 2020 and 6.4 years in 2021 relative to 2019.

CONCLUSIONS

These results underscore the disproportionate share of deaths experienced by Native Americans: a loss in life expectancy at birth in 2020 that is more than three years above that for Whites and about 1.5 years above the losses for the Black and Latino populations. Despite a successful vaccination campaign among Native Americans, the estimated loss in life expectancy at birth in 2021 unexpectedly exceeds that in 2020.

CONTRIBUTION

The increased loss in life expectancy in 2021, despite higher vaccination rates than in other racial/ethnic groups, highlights the huge challenges faced by Native Americans in their efforts to control the deleterious consequences of the pandemic.

Think globally, act locally: Quality improvement as a catalyst for COVID-19 related care during the transitional years

The COVID-19 pandemic has posed distinctive challenges to adolescents and young adults living with spina bifida, especially those from ethic minority populations. With this public health challenge in mind, developing a customized electronic health record to leverage registry data to promote and quantify COVID-19 vaccination uptake among this population is feasible. We provide a brief description of our activities in customizing an electronic health record to track vaccination uptake among adolescents and young adults with spina bifida (AYASB); and the lessons learned, in hopeful support of those scaling-up vaccination delivery across the globe for AYASB as they transition to adult-centered care. Thus, as providers think globally and act locally, COVID-19 immunization efforts can be implemented while providing culturally appropriate transition policies and services for individuals with neurodevelopmental disabilities.