Probst, C., Bright, S., Zhu, Y. et al. (6 more authors) (2025) The COVID-19 syndemic: a perfect storm for the life expectancy of the most disadvantaged Americans. International Journal of Epidemiology, 54 (3). ISSN 0300-5771
Abstract
Background
To explore the syndemic nature of the COVID-19 pandemic by identifying which subpopulations in the United States (US) suffered the greatest losses in life expectancy (LE) in 2020 and 2021, and to which extent these losses can be attributed to COVID-19 and ‘other’ causes of death.
Methods
We analysed individual death records for 2018–2021 from the National Vital Statistics System and population counts from the American Community Survey. Life table and continuous change decomposition analyses were used to quantify cause-/.specific contributions to changes in LE over time in population subgroups defined by sex, educational attainment, and race/ethnicity.
Results
From 2019 to 2020, educational differences in LE (high minus low education) increased substantially by 5.0 and 2.6 years in Hispanic men and women, respectively, with increases of one to two years among Black and White adults. Nearly all losses in LE among high-education Hispanic and White groups were due to COVID-19, while among low-education White and Black groups, COVID-19 accounted for 40%–47% of the total losses in LE. Changes in LE were much smaller during 2020–2021.
Conclusions
COVID-19 widened preexisting inequalities in LE in the US, both via direct mortality and through syndemic interactions with other diseases and health conditions. The underlying social, political, economic, and environmental factors driving the clustering and interaction of diseases among the most disadvantaged Americans need to be addressed.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. |
Keywords: | syndemic, life expectancy; COVID-19 mortality; health inequalities; educational disparities; race and ethnicity |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 28 May 2025 10:36 |
Last Modified: | 28 May 2025 10:36 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/ije/dyaf069 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:227133 |