A study of life expectancy trends in the U.S. released Thursday has found that the gap between Black and white lifespans has nearly doubled over the last two decades, exacerbated by geographic and racial health disparities — and reversing decades of a slow but gradual narrowing of the gap.

The study, published in the journal The Lancet, also found that life expectancies can vary by roughly 20 years, depending on an individual’s race, ethnicity and the economic conditions where they live. The disparities are so stark that the study’s authors divide the nation into ten mutually exclusive populations, which they term “The ten Americas.”

Overall life expectancy in the U.S. had increased nationwide between 2000 and 2010 but had slowed in most of the country by 2019 — before the COVID-19 pandemic drove down longevity across all demographics.

The study’s senior author, Professor Christopher J.L. Murray of the University of Washington, said the study’s findings illustrate health inequality in the U.S.

“The extent and magnitude of health disparities in American society are truly alarming in a country with the wealth and resources of the USA,” said Murray, director of UW’s Institute for Health Metrics and Evaluation in Seattle. “These disparities reflect the unequal and unjust distribution of resources and opportunities that have profound consequences on well-being and longevity, especially in marginalized populations.”

Between the years 2000 and 2021, the gap increased from 12.6 years to 20.4 years in 2021, fueled by the COVID-19 pandemic.

The new study is an updated and expanded version of the landmark “Eight Americas” study published almost 20 years ago. The earlier study examined the drivers of health inequities by dividing the U.S. population into eight groups based on similar categories. However, that study also included homicide rates in its analysis.

The highly detailed look at the life expectancy gap began by splitting the country’s population into ten groups based on geography, race and ethnicity, metropolitan or rural areas, income, and levels of residential segregation.

The results show that in 2000, Black Americans living in rural, low-income counties in the South, as well as Black Americans living in highly segregated cities, had the lowest life expectancy, around 70.5 years for both populations. Asian Americans had the highest lifespan, about 83.1 years on average.

Between 2000 and 2010, however, Black people had experienced the largest gains in life expectancy, increasing by as much as 3.7 years on average. In some parts of the country, such as in Appalachia and the lower Mississippi Valley, Black life expectancy surpassed that of white people living in low-income counties.

Study co-author Thomas Bollyky of the Council of Foreign Relations said the life-expectancy gap between life expectancy at birth for Black and white Americans “may never have been narrower than it was in the mid-2010s.”

It’s likely, he said, that “long-term improvements in education available to Black children and young adults in recent decades, as well as reductions in homicide rates and deaths from HIV/AIDS — causes of death that have disproportionately impacted Black Americans — may have contributed to these noteworthy gains for Black Americans.”

However, in the following decade (2010-2019), improvements in life expectancy at birth for the three Black Americas regions — as well as all the other Americas — largely stalled.

This pattern may be explained by an increase in drug overdose deaths and homicides as well as a slowdown in reductions in cardiovascular disease deaths, likely related to increases in obesity, according to the study.

The first two years of the COVID-19 pandemic triggered a steep drop in life expectancy nationwide and substantially widened racial disparities in lifespan.

For example, Black Americans living in highly segregated cities and rural, low-income counties in the South were expected to live an average 74.9 years and 72.5 years, respectively. But in 2019 Black lifespans fell by approximately 4 years in 2020; however, white, Asian American, and American Indian-Alaska Native people living in other more prosperous counties showed a decline of only 1.4 years.

While the study took a granular look at the problem, co-author Professor Ali Mokdad from IHME said more research is needed “to fully understand why life expectancy is worse for some Americans so we can better tackle the root causes of poor health for the most disadvantaged.”

America’s life expectancy gap won’t diminish “until a comprehensive, coordinated approach that includes preventive measures and public health initiatives that transcend political divides and fosters collaboration and accountability between state, local, and national entities is developed,” Mokdad said. “Only then can we hope to create a more equitable and healthier society for all the Americas—and all Americans.”

Murray agreed: “Policymakers must take collective action to invest in equitable health care, education, and employment opportunities and challenge the systemic barriers that create and perpetuate these inequities so that all Americans can live long, healthy lives regardless of where they live and their race, ethnicity, or income.”

This story first appeared in Word in Black