Title image: Signs along the road from Leupp, Arizona to I-40 encourage people on the Navajo Nation to stay at home. COVID-19 hit the nation's Native American population particularly hard. iStock image by Nancy Wiechec on May 5, 2020.

Life expectancy of Native Americans in the United States dropped by a shocking 4.7 years during the COVID-19 pandemic, about three times that of whites and by far the most of any ethnic group, according to new CU Boulder research.

The study also found that in 2021, while its peer countries around the world appeared to rebound from a historic 2020 dip in life expectancy, the U.S. experienced even higher death rates.

“With the wide availability of vaccines in the United States, there was a lot of optimism that 2021 would look better than 2020,” said co-author Ryan Masters, an associate professor of sociology. “That did not happen. The U.S. didn’t take COVID seriously to the extent that other countries did, and we paid a horrific price for it, with black and brown people suffering the most.”

The paper marks the latest in a series co-authored by researchers at Virginia Commonwealth University (VCU) and the Washington-D.C.-based Urban Institute.

The first, published in the British Medical Journal, found that overall U.S. life expectancy plunged by nearly two years between 2019 and 2020, the greatest dip since World War II. 

Racial minorities were hit hardest, with life expectancy slipping 3.25 years among Black Americans and nearly four years among Hispanics during that time, compared to 1.36 years among whites.

Newly available data offers rare glimpse

For the new paper, which has not yet been peer-reviewed, the team looked at official death data for 2019 and 2020 as well as provisional data for 2021 from the National Center for Health Statistics (NCHS), including newly available data on Native American (American Indian/Alaska Native) mortality.

“As a nation, we tend to be blind to health trends in our Indigenous population because of challenges to collecting accurate data,” said co-author Dr. Steven Woolf, director emeritus of Family Medicine and Population Health at VCU. “Our study provides a rare glimpse into the scale of the disparities they live with and reminds us of the need for systemic change.”

In 2019, the life expectancy of the Native American population in the United States was already the lowest of any racial/ethnic group, at 75 years for women and 68.6 for men. By 2021, those numbers had slipped to 70.4 for women and just under 64 for men.

Previous studies of hospitalized patients have shown that Native Americans died of COVID-19 at a higher rate than any other population. And, according to the Centers for Disease Control, American Indian/Alaskan Native individuals are 1.6 times as likely to be infected with COVID-19, three times as likely to be hospitalized, and twice as likely to die as a result of COVID-19 as whites.

“Native American populations have been ostracized and pushed to the margins to the most extreme extent in this country’s history, so we expected to see a decline in life expectancy,” said Masters, noting that such populations often lack access to vaccines, quality health care and transportation to seek care. “But the magnitude was shocking. You just don’t see numbers like this in advanced countries in the modern day.”

While the world bounces back, the U.S. doesn’t

When the researchers looked at data from the Human Mortality Database and other statistical agencies to glean information about 21 other high-income democratic countries, they discovered another troubling trend:

While the rest of the developed world began to rebound from COVID-19’s toll on life expectancy in 2021, the U.S. did not.

Overall, U.S. life expectancy decreased from 78.85 years in 2019 to 76.98 years in 2020, slipping even further to 76.44 years in 2021—a net loss of 2.41 years. Peer countries, in comparison, saw only .55 years of lost life expectancy between 2019 and 2020 and a 0.26 increase between 2020 and 2021.

Researchers noted that life expectancy during the pandemic actually increased in some countries studied, including in Australia, New Zealand, Norway and South Korea.

Masters attributes the United States’ grim numbers to social inequities, systemic racism and health disparities, such as high rates of obesity and heart disease, that existed long before the pandemic.

Curiously, when looking only at 2021, the new study found that the racial group that experienced the sharpest decline in life expectancy was whites. 

The reason is unclear, but Masters suspects high rates of vaccine hesitancy and resistance to mitigation measures among this population may play a role.

The authors chose to post the research online now, on the preprint server medRxiv, because they believed it held an important and timely message.

“I know we are all ready for this pandemic to be over, but I think we need to hold in our collective memory as a nation just what a devastating toll it has taken and realize that, as demonstrated by our peer countries, much of this was avoidable,” said Masters. “By presenting the numbers, we hope to clarify what happened so we can learn from it.”