The state of California enforced some of the most rigid COVID-19 restrictions, yet also experienced a significant drop in life expectancy during the first two years of the pandemic, according to a new study co-authored by Princeton University, Northwestern University, and other institutions.
The research team — led by Northwestern University professor Hannes Schwandt — found that overall life expectancy in California decreased from 81.4 years in 2019 to 79.2 years in 2020 and 78.4 years in 2021.
Hispanic populations in California lost 5.7 years of life expectancy between 2019 and 2021, while Black populations lost 3.8 years, Asian populations lost 3 years, and white populations lost 1.9 years, according to the study. During this time, income also became more tightly correlated with life expectancy than it had been previously.
In the areas where the richest 1% live, there was hardly any life expectancy loss — less than a year and close to the amount that has been seen in recent years — while in the lowest income areas, four to five years of life expectancy were lost.
The study, published in the Journal of the American Medical Association, is one of the first to demonstrate that the reduction in life expectancy continued from 2020 into 2021, despite the availability of vaccines for much of 2021.
“Our results highlight the disproportionate burden the pandemic placed on low-income people and people of color,” said Janet Currie, the Henry Putnam Professor of Economics and Public Affairs at Princeton University. Schwandt was Currie’s postdoctoral fellow when he was based at Princeton’s Center for Health and Wellbeing.
“We’ve had indications that the pandemic affected economically disadvantaged people more strongly, but we never really had numbers on actual life expectancy loss across the income spectrum,” Schwandt said. “I am shocked by how big the differences were, and the degree of inequality that they reflected.”
In addition to Currie, co-authors included scholars from the University of California, Los Angeles; the California Policy Lab; the National Bureau of Economic Research; and Virginia Commonwealth University (VCU).
The study shows in detail the stark differences in life expectancy loss between people living in high- and low-income census tracts in the U.S., and the disproportionate reduction in life expectancy — even within wealthy areas — for Hispanic, Black, and Asian Californians.
The COVID-19 pandemic hit low-income and minority communities especially hard. Hispanic, Black, and Asian Americans suffered a relatively larger increase in the income-related life expectancy gap compared to non-Hispanic white Americans, according to the study, which examined data on all 1.99 million deaths that occurred in California between 2015 and 2021 to understand how the situation changed after the onset of the pandemic.
Life expectancy gaps between the lowest and highest income census tracts in California grew from 11.5 to 15.5 years between 2019 and 2021, meaning that the lowest income groups lost four years of life expectancy on top of a gap of more than a decade that had already existed before the pandemic.
Life expectancy is not the average lifespan of individuals in a society, but a hypothetical measure based solely on the mortality rates observed in a given year. It estimates how long a cohort of newborns could expect to live if it experienced the mortality rates of that specific year throughout their entire lifetimes.
Life expectancy captures how much life was lost collectively within a population during the pandemic years, and it illustrates the dramatic differences of the pandemic impact across communities of different socioeconomic status.
In the case of the COVID-19 pandemic, viral exposure tended to be higher for people with lower incomes, people who could not work remotely, those who relied more on public transportation, those with housing conditions less conducive to isolating safely.
Other social determinants of health also likely played a role, including pre-existing disparities in co-morbidities, lack of access to health care and systemic racism: Schwandt noted that Hispanic Californians experienced higher life expectancy on average than non-Hispanic white Californians before the pandemic, but that they nevertheless suffered a greater reduction in life expectancy such that their overall life expectancy became lower in 2020.
Asian Americans in California, who historically experienced the longest life expectancy of the four groups studied (Alaska Native and American Indian communities were excluded due to a small sample size in most census tracts), also suffered a greater decrease than white Americans. Black Americans continued to have the lowest life expectancy and suffered greater decreases than any group except Hispanic Americans.
"Life expectancy has always tended to be shorter for Americans on the lower rungs of the income ladder, but this study shows that the pandemic has put those vulnerable families at even greater risk,” said Steven Woolf, director emeritus of the Center on Society and Health at VCU and a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine.
“Even in a state like California, where health is better than in much of the country, devastating losses in life expectancy occurred in low-income communities and the Latino population in particular,” Woolf added.
In addition to Currie, Schwandt, and Woolf, authors of the paper “Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015–2021,” include Till von Wachter and Jonathan Kowarski of the University of California, Los Angeles, and the California Policy Lab; and Derek Chapman of VCU.