Study highlights alarming life expectancy gap in the U.S.

Life expectancy gaps found among ethnic groups: ©Dzmitry - stock.adobe.com

Life expectancy in the United States varies by more than 20 years depending on race, ethnicity, and geographic location, according to a study published in The Lancet. Researchers identified stark disparities that have divided the country into "ten Americas," demonstrating the persistent inequities that undermine the nation’s health progress.

The study, an update of the landmark “Eight Americas” analysis from nearly two decades ago, reveals that the gap in life expectancy has widened substantially over the last 20 years. By 2021, Asian Americans had the longest average life expectancy at 84 years, while American Indian and Alaska Native (AIAN) populations in the West lived, on average, just 63.6 years—a 20.4-year difference.

The research, led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, analyzed trends in life expectancy from 2000 to 2021 using national death records and demographic data. In 2000, the life expectancy gap between the longest- and shortest-living populations was 12.6 years. By 2019, this gap had grown to 15.6 years and expanded further during the COVID-19 pandemic.

“Despite the wealth and resources of the U.S., the extent and magnitude of health disparities are truly alarming,” said senior author Professor Christopher JL Murray, Director of IHME, in a statement. “These disparities reflect systemic barriers to equitable access to health care, education, and economic opportunities.”

Black Americans, historically among the most disadvantaged groups, saw improvements in life expectancy between 2000 and 2010, attributed to reductions in homicide and deaths from HIV/AIDS and cardiovascular disease. However, these gains stagnated in the following decade as the opioid epidemic and rising obesity rates disproportionately impacted marginalized populations.

AIAN populations in the West fared the worst, with life expectancy consistently declining over the study period. The pandemic exacerbated these trends, leading to a 6.6-year drop in life expectancy for this group between 2019 and 2021. The researchers attributed these outcomes to chronic underfunding of Indigenous health services, inadequate access to health care, and the lasting effects of systemic discrimination.

The pandemic dealt a severe blow to life expectancy across all populations, but its impact was most pronounced among marginalized groups. Life expectancy for Black Americans in urban areas fell by approximately four years from 2019 to 2020, compared to a 1.4-year drop for White Americans living in suburban counties.

“These findings underscore the profound vulnerability of marginalized populations during public health crises,” said Thomas Bollyky, a co-author from the Council on Foreign Relations, in a statement. “Long-term improvements in education and healthcare access must be prioritized to narrow these gaps.”

Call to Action for Physicians and Policymakers

Researchers say the study highlights the urgent need for systemic reforms to address these disparities. Preventive care, public health initiatives, and equitable investments in education and employment are critical to closing the life expectancy gap. For physicians, the findings emphasize the importance of tailoring interventions to meet the needs of underserved communities, advocating for policies that address social determinants of health, and engaging in culturally competent care.

“This is a wake-up call,” said Professor Ali Mokdad, a co-author from IHME, in a statement. “Achieving health equity will require a comprehensive approach that transcends political divides and fosters collaboration among state, local, and national stakeholders.”

The study’s authors acknowledged limitations, including potential misclassification of race and ethnicity on death certificates and variability in life expectancy within the same population groups. They emphasized the need for more granular data and further research to better understand the drivers of these disparities.