In 2021, Americans' average life expectancy declined for the second year in a row and is now the lowest it has been in over 25 years, according to a new report from CDC's National Center for Health Statistics (NCHS).

Cheat sheet series: Population health

Report details and key findings

For the report, researchers at NCHS analyzed provisional death records for 2021, which included over 99% of the deaths that occurred that year, to estimate Americans' life expectancy at birth.

Overall, the researchers found that Americans' life expectancy at birth was 76.1 years in 2021—the lowest it has been since 1996. In comparison, life expectancy was 77 years in 2020 and 78.8 years in 2019. The 2.7-year decline in life expectancy between 2019 and 2021 is the largest two-year decline since 1921-1923.

In particular, American Indians and Alaskan Natives saw the largest drop in life expectancy from 2020, going from 67.1 years to 65.2 years. From 2019, this decline was even larger, dropping 6.6 years from 71.8 years. According to Robert Anderson, chief of NCHS's mortality statistics branch, this precipitous decline is similar to what occurred with all Americans after the Spanish Flu pandemic.

"It's a ridiculous decline," Anderson said. "When I saw a 6.6 year decline over two years, my jaw dropped. … I made my staff re-run the numbers to make sure."

The group that saw the second-largest decline in life expectancy from 2020 was white Americans, who saw a one-year decline from 77.4 years to 76.4 years. Black Americans also saw a 0.7-year decline, going from 71.5 years to 70.8 years. Hispanic Americans and Asian Americans had the smallest declines in life expectancy at 0.2 years and 0.1 years, respectively.

The US continual decline in life expectancy is 'very disturbing'

Steven Woolf, a professor of population health and health equity at Virginia Commonwealth University, said the study's findings "are very disturbing" since they show that "U.S. life expectancy in 2021 was even lower than in 2020."

In comparison, other high-income countries have largely seen their life expectancies bounce back to pre-pandemic levels, which makes the United States' continual decline "all the more tragic," Woolf said.

According to the report, much of the decline life expectancy was due to Covid-19, but a rise in accidental deaths, including drug overdoses, heart disease, chronic liver disease, and cirrhosis also contributed to the decrease.

"The COVID-19 pandemic has in effect wiped out the health gains that the U.S. has made in the 20th century," said John Haaga, a member of Maryland's Commission on Aging. "To have this second year of crash basically wiping out the meager gains made during the century is really pretty shocking."

In particular, communities of colors, which often have greater health disparities and higher rates of chronic diseases compared to white communities, have been disproportionately impacted by the pandemic.

"If someone from a community experienced lifelong food insecurity, no proper access to primary care doctors and other adverse experiences, their immune response to a disease like covid would be poor," said Dana Burr Bradley, dean of the Erickson School of Aging Studies at the University of Maryland, Baltimore County.

How the US can improve life expectancy

Writing in the New York Times, Dave Chokshi, a physician at Bellevue Hospital and a visiting fellow at the New York Health Foundation, said that "America is at a fork in the road with respect to the health of the nation."

In one path, the United States would follow what happened after the 1918 flu pandemic, or the "forgotten pandemic." Although life expectancy increased again after flu deaths abated, there were not significant improvements compared to before the pandemic.

However, another path would be similar to the response after the typhus, smallpox, dysentery, and cholera outbreaks of the 19^th century, which led to a "great sanitary awakening" that "changed the way society thought about protecting health as a public responsibility."

In particular, Chokshi recommends the United States focus on social and economic policies, including those that address education and housing assistance, that can greatly impact people's health.

"Lessons from the Covid-19 response ‌‌should also lead to investment in a national public health corps, a cadre of community health workers both serving and drawn from the most marginalized neighborhoods across the country, providing a health work force, economic resources and jobs in one fell swoop," Chokshi writes. "Broader preparedness for the next infectious threat must appropriately resource local and state public health agencies, from laboratory capacity to misinformation response."

Overall, giving people "a reason to vote on the social and economic policies that shape health may be the key to reversing the decline in life expectancy in the United States," Chokshi writes. (Greenhalgh/Simmons-Duffin, "Shots," NPR, 8/31; Sheridan, STAT, 8/31; Reed, Axios, 8/31; Rabin, New York Times, 8/31; Johnson/Malhi, Washington Post, 8/31; Chokshi, New York Times, 8/31)