(CNN) — The life expectancy in the United States it fell for the second straight year in 2021, hitting the lowest level since 1996, according to final mortality data released Thursday by the US Centers for Disease Control and Prevention’s National Center for Health Statistics ( CDC).
Covid-19 was one of the main contributors to the decline in life expectancy, which is now almost two and a half years shorter than it was at the start of the pandemic. After a drop of 1.8 years in 2020another 0.6-year cut last year cut US life expectancy to 76.4 years in 2021.
“What we’re seeing in terms of mortality patterns is being driven, I think, in large part by the pandemic,” said Robert Anderson, head of mortality statistics at the National Center for Health Statistics. The drop is not necessarily surprising, but it is “substantial”.
The final mortality data is less severe than previous estimates predicted; interim data suggested that life expectancy might have dropped by almost a full year in 2021. But it’s still historic: life expectancy typically only changes by 0.1 or 0.2 years.
Nearly 1 in 8 deaths in 2021 was due to covid-19, up from 1 in 10 deaths in 2020. It was again the third leading cause of death. Heart disease remained the leading cause of death, followed by cancer. About half of all deaths last year were due to these three causes.
Drug overdose deaths have also increased significantly during the pandemic, reaching record levels in 2021. Nearly 107,000 people died from drug overdoses in 2021, bringing the age-adjusted overdose death rate to more than 14% in one year. and 50% in the last two years.
“These data are very tragic but not surprising,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “The pandemic had a magnifying effect on an already devastating overdose crisis and exacerbated many of the stressors in society that make people more vulnerable to using drugs.”
Final CDC mortality data shows that between 2020 and 2021, overall mortality rates increased for all age groups except infants under one year of age. But the largest increase was among those aged 35 to 44, a group that bore the brunt of drug overdose deaths.
“We also know that substance use is more dangerous than ever, as fentanyl has continued to permeate the illicit drug supply, increasing the risk of overdose among both people with substance use disorders and those who use drugs occasionally, Volkow said.
Deaths related to synthetic opioids like fentanyl increased by a marked 22% in 2021, according to CDC data. Deaths related to cocaine and psychostimulants such as methamphetamine were also significantly more frequent, while those related to heroin decreased.
Overall, life expectancy for women was almost six years longer than for men in 2021, a similar gap to that in 2020. Age-adjusted death rates were lowest among Asian men and women, while they were higher — and increased significantly — among American Indian and Alaska Native men.
The death rate for black men decreased slightly in 2021, but was still the second highest among demographic groups.
“Any time the death rate goes down, that’s a good thing,” Anderson said. That drop aligns with pandemic patterns, as COVID-19 death disparities narrowed in 2021, she said.
But 2021 life expectancy data broken down by race and ethnicity has yet to be finalized, and life expectancy for black men may have declined even through improving death rates.
“If death rates are disproportionately higher at younger ages than at older ages, that can have a huge effect on life expectancy,” Anderson said.
Whites, however, saw a significant increase in death rates, an increase of around 7% between 2020 and 2021 between men and women, another change that aligns with pandemic trends. Only about half of white people in the US received their initial covid-19 vaccine, well below the national average, and CDC data estimates that the risk of dying from covid-19 was about seven times higher for unvaccinated people in December 2021.
There was an extremely mild flu season last year, with influenza and pneumonia dropping out of the top 10 causes of death in 2021. Along with heart disease, cancer and covid-19, the other leading causes of death in 2021 were : unintentional injuries, of which drug overdoses account for more than a third; spills; chronic lower respiratory diseases; Alzheimer disease; diabetes; chronic liver disease and kidney disease.
Age-adjusted death rates increased for eight of the 10 leading causes of death between 2020 and 2021, changes that are “significant,” Anderson said.
While not directly attributed to Covid-19, many changes in death rates are “almost certainly related to the pandemic,” he said, pointing to the 3% increase in heart disease and the 6% increase in stroke.
“These are the things that need to be watched carefully in the coming years, both in terms of surveillance data and also in terms of final data,” he said. “They need to be monitored to see how things are progressing after the pandemic.”
In the long term, it is difficult to know what the trends in life expectancy will be like.
“We know it didn’t happen in 2022, but by 2023, let’s say everything is back to normal. We could end life expectancy by going back to where it was, essentially,” Anderson said.
“But I think there are enough people who have had (covid) and enough people who have chronic problems caused by covid whose life expectancy is probably going to be reduced in the long run, which may mean higher death rates.”
The opioid epidemic could also hinder progress.
“We have treatments and tools available, but we need to prioritize getting them off the shelf and using them to their full potential,” Volkow said. “To curb the overdose crisis, it is crucial that we put this same urgency and infrastructure into action to accelerate discovery in addiction science, provide treatment and support for people with substance use disorders, and implement prevention interventions to save lives”.
Anderson said there is still a substantial number of deaths from covid-19 in the US, but it is much better than it was.
“I would like to think that we will return to at least a trend of increasing life expectancy. But how long it will take us to get back to 2019 is hard to know,” she said.