Northwestern study finds California life expectancy yet to recover since COVID-19
A new study from Northwestern University found that life expectancy in California has not returned to pre-pandemic levels, data that could indicate similar national trends.
The study, published in the Journal of the American Medical Association, found that overdoses and cardiovascular diseases were the leading causes of life expectancy loss in California.
COVID-19 also remained a contributing factor.
Hannes Schwandt, Northwestern professor and lead researcher of the study, and his team analyzed California data because it is comprehensive and typically published ahead of the Centers for Disease Control and Prevention's national data. The researchers used California's Comprehensive Death Files and obtained population counts for calculating mortality rates from the American Community Survey.
"California is the biggest state [by population], so it gives us an idea of trends," he said.
Life expectancy is the estimated lifespan of a human based on prevailing age specific mortality rates, according to Northwestern University.
"2020 was bad, 2021 was even worse, and then we didn't see a rebound, or even overshooting in life expectancy the next year. We saw continued deficit in life expectancy compared to 2019," Schwandt said.
Schwandt compared it to the 1918 influenza pandemic, in which multiple studies show that life expectancy in the United States rebounded after one to two years, unlike COVID-19, which continues to impact life expectancy over five years later.
Study findings
The study found that Californians' life expectancy dropped nearly a year from 81.4 to 80.5 by 2024.
While the life expectancy gap between income groups returned to pre-pandemic levels by 2024 after widening during 2020–2023, disparities between racial groups grew even larger.
In 2024, Black people lived on average six and a half years less than white people in California.
Black Californians experienced a slower but more prolonged decline in life expectancy: losing four years by 2021 due to COVID deaths, but the gap further widened due to fentanyl overdoses.
Hispanic Californians had the most severe single-year life expectancy drop of five years in 2021 due to COVID-19. Still, overdoses and cardiovascular disease continue to reduce their life expectancy by more than a year.
Overdoses impacted poor communities the hardest, while cardiovascular disease was the primary cause for the drop in life expectancy for wealthier and white people.
Correlation with fentanyl epidemic
"The fentanyl crisis particularly took off in 2020 and continues to be a problem," Schwandt said.
Other research studies show a strong correlation between the COVID-19 pandemic and the fentanyl epidemic.
A study published in the National Library of Medicine calls the pandemic an "important epoch in the opioid epidemic timeline." Societal disruptions, economic stress, and limited access to treatment increased the risk of overdoses, according to the study.
Schwandt also said that overprescribing opioids is a part of the larger problem.
In 2024, 87% of opioid overdose deaths in Cook County involved fentanyl. African Americans make up 53% of those total overdose deaths.
A Penn State study found that by the start of the pandemic, a Black person over the age of 55 in Illinois, Wisconsin, and Minnesota was 5 times more likely to die of a drug overdose than a white person of the same age.
"The good news is that in 2024, overdose deaths did decline for the first time," Scwandt said. "But because they increase so dramatically over the years, we are still in a territory that is unacceptable."
Provisional data from the CDC found a nearly 24% decline in US drug overdose deaths.
Long COVID and cardiovascular disease
Schwandt said that increased deaths from cardiovascular disease could be potentially linked to obesity and Long COVID.
"I think that's a really interesting hypothesis that we should explore more," he said.
"Maybe in richer areas, people have more access to COVID treatment and survive, have a higher burden of Long COVID, which then could lead to higher cardiovascular mortality," Schwandt said.
Long COVID is an all-encompassing name for the long-term symptoms and health effects a person can experience after contracting COVID-19, regardless of the severity of the case. Long COVID is a disorder that can impact almost all parts of the body, including the heart, brain, immune system, and gastrointestinal system.
A 2024 study published in the European Journal of Preventive Cardiology found that "undeniably, the Long COVID syndrome has a multifaceted interplay with the cardiovascular system."
The researchers looked at 78 different studies to compile different cardiovascular manifestations of Long COVID and found that cardiac symptoms are the third most common clinical manifestation of the disease.
Learning from other countries
Schwandt examines trends in life expectancy and compares the data in the U.S. to that of other developed countries to see how the U.S. can increase its life expectancy.
"Countries like Spain, that have lower incomes, and less technology, and they're healthier and live longer [than the US]," he said.
He looks at different causes, areas, and incomes throughout the U.S. and other developed countries to determine who is living the longest and why.
Schwandt wants to expand the study once the U.S. numbers are available to researchers.
"I'd like to analyze the data in rich and poor populations in other developed countries and compare them to the U.S. experience," he said. "How is the world recovering, and is there anything we can learn from that?"