The higher prevalence of comorbid conditions in many racial or marginalized communities is a reflection of unequal access to social determinants of health more than it is their race or ethnicity, researchers suggest.
Life expectancy in the United States between 2018 and 2020 decreased by 1.87 years (to 76.87 years), which is 8.5 times the average decrease in other high-income nations. What's more, decreases in life expectancy among Hispanic and non-Hispanic Black people were about two to three times greater than in the non-Hispanic White population, reversing years of progress in reducing racial and ethnic disparities. The life expectancy of Black men (67.73 years) is the lowest since 1998.
Those are key findings of a study conducted by researchers at the Virginia Commonwealth University School of Medicine, the University of Colorado Population Center and the Urban Institute in Washington, D.C., and published in The BMJ — a peer-reviewed medical trade journal of the British Medical Association.
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Researchers (noting that the United States has more COVID-19 pandemic-related deaths than any other country) set out to estimate the changes in life expectancy in 2010 to 2018 and during the pandemic in 2020 across population groups in the United States and then compare those changes with peer nations. The study was based on all deaths in the United States and 16 other high-income countries: Austria, Belgium, Denmark, Finland, France, Israel, Netherlands, New Zealand, Norway, South Korea, Portugal, Spain, Sweden, Switzerland, Taiwan, and the United Kingdom.
"A longstanding and widening U.S. health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism," researchers concluded, adding that "long before COVID-19, the U.S. was at a disadvantage relative to other high-income nations in terms of health and survival."
The study's three authors noted that the most recent decreases in life expectancy are "exacerbated by limited access to health care and by widespread social and economic disruptions produced by the pandemic (e.g., unemployment, food insecurity, and homelessness). … Extensive research has shown that systems of power in the U.S. structure opportunity and assign value in ways that unfairly disadvantage Black, Hispanic, Asian, and Indigenous populations, and unfairly advantage White people. Many of the same factors placed these populations at greater risk from COVID-19."
The higher prevalence of comorbid conditions in many racial or marginalized communities is a reflection of unequal access to social determinants of health — such as education and income — more than it is their race or ethnicity, researchers added.
"Low-income communities and women have also been disproportionately affected by the social, familial, and economic disruptions of the pandemic," they wrote. "Reduced access to COVID-19 vaccines, and vaccine hesitancy rooted in a community's distrust of systems that have mistreated them, might exacerbate these disparities. Structural factors affect not only Black and Hispanic populations but other marginalized people and places."
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