Notably, every age group in the U.S. — from young children to seniors 85 and older — saw a rise in its death rate. Men, women and most racial groups lost ground. In some previous years, even when overall life expectancy declined, some groups advanced.
“This one, it’s sort of across-the-board bad news,” said Eileen Crimmins, a professor of gerontology at the University of Southern California who studies life expectancy around the world. “We’ve gone since 1996 without improving. That’s incredible, given how much we’ve learned about medicine, how much we’ve spent.”
The government reported last week that health care spending in 2021 reached nearly $13,000 per person.
The data reinforces a trend line of American longevity declining relative to that of its peer nations. A child born in the United States in 2019, for instance, could expect to live to 78.5, according to the World Health Organizationwhile a Japanese child born that year had a life expectancy of 84.5, Belgians lived to 81.4 and Swedes lived to 82.4.
In all, 3.46 million people died in the United States in 2021 — 80,502 more than the previous year. Covid killed 416,893, and drug overdoses were responsible for 106,699 deaths — slightly fewer than the more than 107,000 the government had cited based on preliminary data. At birth, women could expect to live 79.3 years in 2021, and men could expect to live to 73.5 — life spans that declined sharply from 2020.
In 2021, heart disease and cancer, the two leading causes of death in the United States, saw little change. The top ten causes of mortality remained the same except for flu and pneumonia, which dropped from the list as parts of the U.S. population wore masks to protect against the coronavirus. Diseases of the liver, often related to alcohol use and viruses, replaced flu and pneumonia.
The 2021 decline was the second consecutive drop for the United States and the continuation of a trend that began in the middle of the last decade, when “deaths of despair” — those caused by drug overdoses, suicide and alcoholism — rose markedly.
It also contrasted with rebounding life expectancy rates in some other nations as they brought the covid pandemic under greater control with vaccines and masking. A study of 29 countries published in August in the journal Nature Human Behavior found that eight experienced significant life expectancy “bounce backs” in 2021.
They included Belgium, Switzerland, Spain, France and other mainly Western countries, The United States was among the 12 where life expectancy continued to drop. They included Germany, Chile, Bulgaria, Greece and Estonia, among others.
“With the vaccine available, and other pandemic control measures, a lot of other countries did recover,” said Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University’s School of Medicine. “The fact that it has happened in other countries tells us it’s possible to do.”
But few other countries faced hundreds of thousands of deaths from covid, coupled with an unrelenting drug overdose epidemic largely caused by the illicit synthetic opioid fentanyl. Drug overdoses rose by 14 percent last year and have quintupled in two decades. Those overdoses took more lives last year in every age group 25 and over, and in every group except Asian men.
Fentanyl did about two-thirds of the damage. The Drug Enforcement Administration reported Tuesday that it had seized 379 million doses of fentanyl in 2022, enough “to kill everyone in the United States,” according to DEA Administrator Anne Milgram. Still, authorities estimate they are catching just 5 to 10 percent of the illegal fentanyl that crosses the southern border.
Deaths from methamphetamine and cocaine also rose sharply last year. Experts have speculated that fentanyl may be implicated in some of those fatalities because it is laced throughout the drug supply, causing some users to ingest it unknowingly.
Magdalena Cerda, a professor in the Department of Population Health at the NYU Grossman School of Medicine, said people who believe they’re consuming cocaine or methamphetamine may not be taking precautions. such as having naloxone, an antidote to opioid overdoses, or fentanyl test strips on hand.
“People think they’re taking just cocaine or just methamphetamines, but they’re taking fentanyl as well,” she said.
Many people who die of overdoses have multiple drugs in their systems.
“This is certainly heartbreaking,” said R. Kathryn McHugh, chief of psychology at McLean Hospital in Massachusetts. “This is 106,000 people with families who aren’t here anymore.”
The data show that fentanyl appears to be replacing heroin, a much less powerful opioid. Deaths from that drug fell 32 percent over the previous year, the government reported.
As they have for years, experts cited the anomalies of life in the United States as they tried to explain the country’s declining life expectancy. These include the lack of universal health care, the huge number of deaths from gun violence, the widening income gap between rich and poor, consumption of unhealthful foods, poor government support for housing and child care and many other social and economic factors.
“My contention is that there are choices we make as a society, and policymakers make in the United States, that other countries aren’t making,” said Woolf, the VCU professor.
McHugh and Cerda called for stepping up treatment efforts to combat the ever-worsening drug epidemic by boosting access to medications such as buprenorphine, methadone and naltrexone. They also said the U.S. must expand the use of harm reduction techniques by widening distribution of naloxone, syringe services and fentanyl test strips.
“Many of the tools that need we already have,” McHugh said. “We just need to be deploying them better.”