Objective To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations. Design Simulations of provisional mortality data. Setting US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity. Population Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively. Main outcome measures Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles. Results Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared. Conclusions The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.

https://www.bmj.com/content/bmj/373/bmj.n1343.full.pdf

Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data.

Importance Medicaid expansions as part of the Patient Protection and Affordable Care Act (ACA) are associated with decreases in the percentage of uninsured patients who have received a new diagnosis of cancer. Little is known about the association of Medicaid expansions with stage at diagnosis and time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). Objective To determine the association of Medicaid expansions as part of the ACA with stage at diagnosis and TTI for patients with HNSCC. Design, Setting, and Participants A retrospective cohort study was conducted at Commission on Cancer–accredited facilities among 90 789 patients identified from the National Cancer Database aged 18 to 64 years with HNSCC that was diagnosed during the period from January 1, 2010, to December 31, 2016. Statistical analysis was conducted from February 18 to November 8, 2019. Main Outcomes and Measures Outcome measures included health insurance coverage, stage at diagnosis, and TTI. Absolute percentage change in health insurance coverage, crude and adjusted difference in differences (DD) in absolute percentage change in coverage, stage at diagnosis, and TTI before (2010-2013) and after (2014-2016) ACA implementation were calculated for Medicaid expansion and nonexpansion states. Results Of the 90 789 nonelderly adults with newly diagnosed HNSCC (mean [SD] age, 54.7 [7.0] years), 70 907 (78.1%) were men, 72 911 (80.3%) were non-Hispanic white, 52 142 (57.4%) were between 55 and 64 years of age, and 54 940 (60.5%) resided in states with an ACA Medicaid expansion. Compared with nonexpansion states, the percentage of patients with HNSCC with Medicaid increased more in expansion states after the implementation of the ACA (adjusted DD, 4.6 percentage points [95% CI, 3.7-5.4 percentage points]). The percentage of patients with localized disease (American Joint Committee on Cancer stage I-II) at diagnosis increased in expansion states compared with nonexpansion states for the overall cohort (adjusted DD, 2.3 percentage points [95% CI, 1.1-3.5 percentage points]) and for the subset of patients with nonoropharyngeal HNSCC (adjusted DD, 3.4 percentage points [95% CI, 1.5-5.2 percentage points]). The mean TTI did not differ between expansion and nonexpansion states for the cohort (adjusted DD, –12.7 percentage points [95% CI, –27.4 to 4.2 percentage points]) but improved for patients with nonoropharyngeal HNSCC (adjusted DD, –26.5 percentage points [95% CI, –49.6 to –3.4 percentage points]). Conclusions and Relevance This study suggests that Medicaid expansions were associated with a greater increase in the percentage of patients with HNSCC with Medicaid coverage, an increase in the percentage of patients with localized disease at diagnosis for the overall cohort of patients with HNSCC, and improved TTI for patients with nonoropharyngeal HNSCC.

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Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma

Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex.

Women of working age (ages 19–64) faced specific challenges in obtaining health insurance coverage and health care before the Affordable Care Act. Multiple factors contributed to women’s experienci...

Women’s Coverage, Utilization, Affordability, And Health After The ACA: A Review Of The Literature

Purpose To compare insurance status in cancer patients receiving radiation before and after Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), in both expanded and non-expanded states. Methods and Materials Newly diagnosed cancer patients aged 18 to 64 years who received radiation from 2011 to 2014 were compiled from the Surveillance, Epidemiology, and End Results database. Patients with a prior cancer diagnosis or unknown insurance status were excluded. Insurance rates at diagnosis were examined before (2011-2013) and after Medicaid expansion (2014) and compared between states that fully or did not fully expand Medicaid. Results A total of 197,290 patients were analyzed. Of these, 73% lived in expanded states. After expansion, there was a 53% relative decrease in uninsured rates in expanded states (4.3%-2.1%) and a 5% relative decrease in non-expanded states (8.4%-8.0%) (P Conclusions Medicaid expansion in 2014 significantly decreased uninsured rates for cancer patients receiving radiation. Full expansion decreased rates of uninsurance to a greater degree and seemed to decrease racial and economic disparities.

Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act.

Importance To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country’s biggest cities. Objectives To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade. Design, Setting, and Participants This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020. Exposure City of residence. Main Outcomes and Measures Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios. Results The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, −0.10%; 95% CI, −0.34% to 0.14%;P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, −0.51%; 95% CI, −0.92% to −0.09%;P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]). Conclusions and Relevance In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.

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Comparison of All-Cause Mortality Rates and Inequities Between Black and White Populations Across the 30 Most Populous US Cities.

Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment

Diabetes mortality across the 30 biggest U.S. cities: Assessing overall trends and racial inequities.

Homicide Mortality Inequities in the 30 Biggest Cities in the U.S.

Influenza and pneumonia account for substantial morbidity in the United States and show a demonstrated racial inequity. Detailed race-specific analysis at the city level can be used to guide targeted prevention efforts within the most at-risk communities. The purpose of this study is to analyze city-level data of influenza/pneumonia mortality rates and racial disparities across the 30 biggest U.S. cities over time. We assess racial inequities in influenza/pneumonia mortality in the 30 biggest cities and compare city-level trends overtime through age-adjusted overall and race-specific mortality rates calculated from public death records for the years 2008-2017. The national influenza/pneumonia mortality rate significantly decreased as did 45% of the cities included in the study. Nationally, the Black mortality rate was 16% higher than White mortality rate, and a significant disparity was seen within about one-third of the biggest cities. Over half (56%) of the cities showed reductions in both Black and White mortality; however, there was no overall trend in racial equity with some cities reducing the inequities between the Blacks and Whites and others increasing the inequities. Elevated mortality rates in communities of color can be traced to structural racism, social factors, and access to treatment and prevention services. We recommend an approach utilizing community outreach administered through localized public health organizations and supported by data at the city level.

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Nazia Saiyed

Papers

Comparison of All-Cause Mortality Rates and Inequities Between Black and White Populations Across the 30 Most Populous US Cities.

Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment

Diabetes mortality across the 30 biggest U.S. cities: Assessing overall trends and racial inequities.

Homicide Mortality Inequities in the 30 Biggest Cities in the U.S.

Influenza and Pneumonia Mortality Across the 30 Biggest U.S. Cities: Assessment of Overall Trends and Racial Inequities.