Life expectancy didn’t return to baseline after COVID pandemic, data suggest

While life expectancy in California edged up after plunging in 2021 amid the height of the COVID-19 pandemic, it hasn’t fully rebounded, a Northwestern University-led study suggests.

The research team analyzed death data for 2019 to 2024 from the California Comprehensive Death Files and population counts from the American Community Survey, publishing their findings last week in JAMA.

The researchers calculated life expectancy—the estimated lifespan of a hypothetical group of newborns based on current age-specific death rates—for the state. They also calculated life expectancy by quartile based on median income in census tracts and by the four racial groups (Hispanic, Asian, Black, and White) recorded on death certificates.

“US life expectancy plummeted during the COVID-19 pandemic and increased in 2022-2023,” the study authors wrote. “Although estimates for 2024 have not been reported for the US, vital statistics through 2024 are available for California.”

Drug overdoses accounted for large deficits in 2021-2023

Life expectancy in California rose slightly in the years leading up to the pandemic but fell sharply after 2019, bottoming out in 2021. Life expectancy regained lost ground thereafter but was still 0.86 year lower in 2024 than in 2019. 

While people living in the lowest-income census tract quartile (Q1) lost more life expectancy than the highest-income group (Q4; eg, 4. vs 1.75 years in 2021), the gap between Q1 and Q4 in 2024 was similar to that in 2019 (5.77 vs 5.63 years).

Life-expectancy deficits relative to 2019 were greater in Hispanic and Black people than in their Asian and White counterparts (eg, 5.18, 4.04, 2.73, and 2.18 years in 2021, respectively). The Hispanic population recovered from losses in 2020-2021, when its life expectancy was lower than that of White people, but the advantage over the White population was lower in 2024 than in 2019 (1.17 vs 1.98 years). The life-expectancy gap between Black and White people was higher in 2024 than in 2019 (6.52 vs 5.67 years).

Relative to 2019, in 2021, COVID-19 accounted for 1.22 years (61.6%) of the life-expectancy deficit, after which non-COVID conditions became a larger contributor. Drug overdoses and cardiovascular disease made up 20.4% of the deficit in 2020 and 49.9% in 2023. Drug overdoses were a larger contributor in Q1 than in Q4 (36.6% vs 12.7% in 2023), while cardiovascular disease made a smaller contribution (11.5% vs 26.2%).

The increasing contribution of drug overdoses to life-expectancy losses in 2021-2023 affected all four racial groups but was strongest among Black people. Overdoses accounted for 0.99 years of the deficit in Black people in 2023, versus 0.42 years in Hispanic and White people and 0.08 years in Asians. Overdoses had a smaller role in life-expectancy declines in 2024 than in 2023 across California (0.17 vs 0.40 years).

Role of exposure to fentanyl, obesity

“Although a prior analysis of California data reported that the life expectancy–income gradient increased during 2020-2021, by 2024 the gap between Q1 and Q4 returned to prepandemic levels,” the researchers wrote. “Life expectancy in the Black population was much lower than in other racial and ethnic populations, and Black and Hispanic populations experienced the largest deficits.”

Life expectancy in the Black population was much lower than in other racial and ethnic populations, and Black and Hispanic populations experienced the largest deficits.

The near-doubling of the contribution of drug overdoses to the life-expectancy deficit from 2020 to 2023, which had a disproportionate effect on low-income and Black Californians, likely reflected greater exposure to the synthetic opioid fentanyl, the authors said. The substantial contribution of cardiovascular disease to deficits throughout the study, especially in high-income areas, which the researchers said is consistent with the state’s rising obesity rates.

“Study limitations include potential misclassification of causes of death, preliminary 2024 death and population counts, reliance on place (census tract–based rather than individual-level income), and the inability to quantify the contribution of long COVID,” the team wrote. “Results for California may not be generalizable to other states.”