Notably, every age group in the U.S.—from toddlers to seniors 85 and over – death rate rises. Men, women and most racial groups lost their edge. Over the past few years, even as overall life expectancy has declined, some groups have improved.
“It’s bad news across the board,” said Erin Crimmins, a professor of gerontology at the University of Southern California who studies life expectancy around the world. “We haven’t improved since 1996. It’s incredible how much we’ve spent considering how much we know about medicine.”
The government reported last week that health care spending per capita in 2021 will be nearly $13,000.
The data reinforces the trend line of declining life expectancy in the U.S. relative to other countries. For example, according to the World Health Organization, the life expectancy of a child born in the United States in 2019 was 78.5 years, compared with 84.5 years for a child born in Japan, 81.4 years for a Belgian and 82.4 years for a Swede.
A total of 3.46 million people will die in the United States in 2021, an increase of 80,502 from the previous year. Covid has killed 416,893 people and drug overdoses have killed 106,699 — just shy of the more than 107,000 the government cited, based on preliminary figures. By 2021, life expectancy at birth will be 79.3 years for women and 73.5 years for men—a sharp decline from 2020.
Heart disease and cancer, the two leading causes of death in the United States, are little changed in 2021. The top 10 causes of death remained unchanged, except for flu and pneumonia, which fell off the list as parts of the U.S. population wear masks to protect against the coronavirus. Liver disease, usually associated with alcohol consumption and viruses, replaced flu and pneumonia.
The 2021 decline is the second in a row in the U.S. and a continuation of a trend that started in the middle of the past decade, when “deaths of despair” — deaths caused by drug overdoses, suicides and alcoholism — rose markedly.
It also contrasts with life expectancy rebounds in some other countries as they contained the covid pandemic at Better control through vaccines and masking. A study of 29 countries published in August in the journal Nature Human Behavior found that eight saw a significant “rebound” in life expectancy in 2021.
They include Belgium, Switzerland, Spain, France and The United States is one of 12 countries where life expectancy continues to decline compared to other, mostly Western countries. These include Germany, Chile, Bulgaria, Greece and Estonia, among others.
“With a vaccine and other pandemic control measures available, many other countries did recover,” said Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University School of Medicine. “The fact that it happened in other countries tells us this is possible.”
But few other countries face hundreds of thousands of deaths from covid, combined with a relentless overdose epidemic mainly caused by illicit drugs The synthetic opioid fentanyl. Drug overdoses increased by 14% last year and have increased fivefold in 20 years. Drug overdoses claimed more lives last year in every age group 25 and older, and in all groups except Asian-American men.
fentanyl did About two-thirds of the damage. The DEA reported Tuesday that it seized 379 million doses of fentanyl in 2022, enough to “kill everyone in the United States,” said DEA Director Anne Milgram. Still, authorities estimate they catch only 5 to 10 percent of the illicit fentanyl that crosses the southern border.
Deaths from methamphetamine and cocaine have also risen sharply last year. Experts speculate that fentanyl may have been involved in some of these deaths because it runs through the drug supply, leading some users to unknowingly ingest it.
Magdalena Cerda, a professor in the Department of Population Health at NYU Grossman School of Medicine, said people who think they’re using cocaine or methamphetamine may not be taking precautions. Examples include naloxone, an opioid overdose antidote, or fentanyl test strips on hand.
“People think they’re just taking cocaine or methamphetamine, but they’re also taking fentanyl,” she said.
Many people who die from drug overdose have multiple drugs in their system.
“It’s definitely heartbreaking,” said R. Kathryn McHugh, director of psychology at McLean Hospital in Massachusetts. “That’s 106,000 people whose family members are no longer here.”
Fentanyl appears to be displacing heroin, a much less powerful opioid, the data show. The government reported a 32 percent drop in deaths from the drug from the previous year.
For years, experts have cited anomalies in American life when trying to explain the decline in life expectancy in the United States. These include lack of universal health care, high numbers of deaths from gun violence, widening income gaps between rich and poor, consumption of unhealthy food, poor government support for housing and child care, and many other social and economic factors.
“My point is that we as a society are making choices, and policymakers in the United States are making choices that other countries are not making,” said Virginia Commonwealth University professor Woolf.
McHugh and Cerda called for intensified treatment efforts to combat the worsening drug epidemic by increasing access to drugs such as buprenorphine, methadone and naltrexone. They also said the U.S. must expand access to harm reduction technologies by expanding the distribution of naloxone, syringe services and fentanyl test strips.
“We already have many of the tools we need,” McHugh said. “We just need to get better at deploying them.”