Life expectancy in the United States dropped considerably during the Covid-19 pandemic — more than almost all other countries included in a new in-depth analysis by researchers in Europe. While some countries have already seen their life expectancies bounce back after an initial decline in 2020 and 2021, the U.S. is likely to experience long-term reductions that were worsened by, but not limited to, Covid-related deaths.

The study covered data from 29 countries, including most of Europe, the U.S., and Chile. From 2019 to 2021, researchers found that average life expectancy in the U.S. dropped nearly 2.5 years — worse than all other countries except Bulgaria and Slovakia. The researchers also highlighted a few remarkable countries that saw no declines in life expectancy in 2020: Norway, Denmark, New Zealand, and Australia. In general, they managed the pandemic far more effectively.

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To be clear, the reduction in U.S. life expectancy was not the third worst in the entire world. Study authors noted that limited data availability from many countries makes it impossible to perform the same rigorous analysis. In fact they say “emerging evidence suggests even larger losses” in places like India and Latin America.

Life expectancy-rattling events — what the researchers refer to as “mortality shocks” — have happened many times before. In the study, the authors cite examples including World War I, World War II, and the Spanish flu. Since life expectancy is a snapshot of a population’s health at any given time, periods with high mortality reduce life expectancy and periods of lower mortality increase it. After mortality shocks including the examples above, life expectancy tends to rebound quickly, getting back to pre-crisis levels within a year or two.

While that trend is holding up for many countries, the situation is not nearly so rosy in the U.S. Even before the pandemic, the country was grappling with what the researchers call a “pre-existing mid-life mortality crisis” — driven in particular by drug overdoses and homicides among working-age men.

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In countries that managed to reverse life expectancy declines after the initial pandemic loss, it was because of aggressive use of Covid vaccines. But in the U.S., vaccine hesitancy among certain groups led to sustained impact, even after the treatments were available. Better vaccine uptake among people older than 65 meant that group did bounce back. In 2021, mortality rates for those over age 80 in the U.S. went back to normal levels, while mortality remained elevated in those under 60 and led to continued reductions in the country’s overall life expectancy. “Excess mortality among under-60s explained more than half of the loss in US [life expectancy] since the start of the pandemic,” the study authors report.

Indeed, the long-term reduction in life expectancy in this country may look more like the “protracted mortality crisis” that occurred in Russia and Eastern Bloc countries starting in the 1960s and lasting into the 1990s, driven in part by a public health failure to reduce smoking and heavy drinking, according to the researchers. This kind of sustained impact means a population is less healthy, often with shorter life spans, more health problems, and less ability to respond well to a new health crisis.

“Extrapolating our findings from 2021, it is plausible that countries with ineffective public health responses will see a protracted health crisis induced by the pandemic … while other regions manage a smoother recovery to return to pre-pandemic trends,” the researchers conclude.