The 10 Americas: Persistent and Widening Life Expectancy Disparities in the US

Life expectancy gaps in the United States have widened dramatically over the past 2 decades.

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Life expectancy gaps in the United States have widened dramatically over the past two decades, with disparities across racial, ethnic, and geographic lines reaching a staggering 20.4 years by 2021, according to a study published in The Lancet.¹ The research, an expansion of the landmark Eight Americas study, reveals how structural inequities and the COVID-19 pandemic have deepened health divides, leaving some groups—particularly American Indian and Alaska Native populations in the West—facing steep declines in longevity.

The mortality disparities observed in the previous research found that among the 8 Americas, each containing millions of individuals were significantly pronounced when compared internationally. The authors noted that these variations in life expectancy cannot be fully explained by race, income, or access to basic health care alone.²

By analyzing data from 2000 to 2021 in the new study, researchers identified 10 distinct "Americas" based on race, ethnicity, geography, income, and segregation levels, revealing a widening gap in life expectancy among these groups.¹

“Revisiting the Eight Americas study two decades later has provided important insights into where progress has (or has not) occurred, and how an inter-related set of contextual factors have contributed to the USA failing so many Americans and falling behind so many of its peer nations,” the researchers wrote. “At the beginning of the 21st century, there was already a 12.6-year gap in life expectancy among Americas, but this gap grew even larger during the 2000s and 2010s and accelerated to 20·4 years after the first 2 years of the COVID-19 pandemic.”

Life Expectancy Trends Across 10 Americas

The study categorized the US population into 10 mutually exclusive groups, refining the original 8 Americas by adding 2 additional groups representing the Latino population.

The 10 Americas defined:

1. America 1: Asian individuals
2. America 2: Latino individuals in other counties
3. America 3: White (majority), Asian, and American Indian or Alaska Native (AIAN) individuals in other counties
4. America 4: White individuals in non-metropolitan and low-income Northlands
5. America 5: Latino individuals in the Southwest
6. America 6: Black individuals in other counties
7. America 7: Black individuals in highly segregated metropolitan areas
8. America 8: White individuals in low-income Appalachia and the Lower Mississippi Valley
9. America 9: Black individuals in non-metropolitan, low-income Southern areas
10. America 10: AIAN individuals in the West

In 2000, life expectancy ranged from 70.5 years for America 9 to 83.1 years for America 1, a gap of 12.6 years. By 2021, the gap had widened to 20.4 years, with America 9 at 65.2 years and America 1 at 85.6 years. Data showed that disparities grew particularly sharply during the first 2 years of the pandemic.

Growing Disparities in Life Expectancy

From 2000 to 2019, most Americas experienced improved life expectancy, with notable gains for Black populations (Americas 6, 7, and 9). However, America 10, comprising AIAN individuals in the West, experienced consistent declines even before the pandemic. During the COVID-19 pandemic, life expectancy dropped significantly across most groups, but the decline was especially pronounced for America 10, exacerbating pre-existing disparities.

Key shifts in life expectancy and socioeconomic factors have been notable in the Americas over the years. By 2010, America 6 surpassed America 8 in life expectancy, attributed to significant improvements in the former while the latter experienced stagnation. From 2000 to 2019, America 5 saw faster increases in life expectancy, although this trend dramatically reversed in 2020. Meanwhile, America 3 consistently ranked highest in income and educational attainment, yet it fell short in life expectancy compared to America 1.

Drivers of Disparity: The Role of Geography, Race, and Income

The study highlights the complex interplay of geographic, racial, and economic factors in shaping health outcomes. While income and education levels influenced disparities, they did not entirely account for the differences, underscoring the importance of structural and systemic inequities.

The COVID-19 pandemic magnified these vulnerabilities, with socially and economically disadvantaged groups experiencing disproportionate impacts on health and mortality. According to the study, the results emphasize the need for targeted, data-driven policies to address health inequities.

Implications for Policy and Action

“Life expectancy declined in all ten Americas in 2020, and rebounded partly in only three Americas in 2021, with the Americas that were worst off before the pandemic seeing some of the largest overall losses from 2019 to 2021,” the authors wrote. “These persistent inequities among ten different Americas warrant urgent attention. We hope these estimates inspire action and serve as one tool (among many) for guiding the development of interventions to reduce and ultimately eliminate these inequities by focusing on the health of the most marginalised Americans. By addressing these disparities head-on, we can take an important step towards achieving health equity and improving the wellbeing of all Americans.”

The study identified 5 key findings related to health disparities in the US. Firstly, the AIAN population in the West is experiencing a severe health crisis, with declining life expectancy due to systemic issues. Secondly, while Black Americans made progress in life expectancy during the early 2000s, these gains have stalled in recent years. Thirdly, Latino Americans exhibit significant regional disparities, particularly in the Southwest. Fourthly, the COVID-19 pandemic exacerbated life expectancy declines among AIAN, Black, and Latino populations, driven by systemic racism and socioeconomic inequities. Finally, there are notable inequalities among White Americans, especially in Appalachia and the Lower Mississippi Valley, where life expectancy has stagnated or declined, emphasizing the influence of geography and income on health outcomes.

“The extent and magnitude of health disparities in the USA are truly alarming. In a country with the wealth and resources of the USA, it is intolerable that so many are living in conditions and with health outcomes akin to those of an entirely different country,” the authors concluded. “These disparities reflect the unequal and unjust distribution of resources and opportunities and have profound consequences for the wellbeing and longevity of marginalised populations. It is time for us to take collective action; to invest in equitable health care, education, and employment opportunities; and to challenge the systemic barriers that create and perpetuate these disparities.”

References

1. Dwyer-Lindgren L, Baumann MM, Li Z, et al. Ten Americas: a systematic analysis of life expectancy disparities in the USA. Lancet. 2024;404(10469):2299-2313. doi:10.1016/S0140-6736(24)01495-8

2. Murray CJ, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States [published correction appears in PLoS Med. 2006 Dec;3(12):e545]. PLoS Med. 2006;3(9):e260. doi:10.1371/journal.pmed.0030260