the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 1
R E S E A R C H
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
Steven H Woolf,1 Ryan K Masters,2 Laudan Y Aron3
ABSTRACT
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 15 and 18 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.
Introduction
In 2020, covid-19 became the third leading cause of
death in the United States1 and was thus expected to
substantially lower life expectancy for that year (box
1). The US had more deaths fr ...
However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a “lost generation” (36) whose future is less bright than those who preceded them.
Life Expectancy and Mortality Rates in the United States, 1959-2017Jim Bloyd, DrPH, MPH
Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.
Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.
Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.
Conclusions and Relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
Dr Yousef Elshrek is One co-authors in this study >>>> Global, regional, and...Univ. of Tripoli
Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Mortality and Causes of Death Collaborators*
Dr. Yousef Elshrek is Coauthors in this study
The rate of alcohol-related deaths has accelerated in recent years, according to a new analysis of U.S. mortality data between 2000-2016. Here's more:
•Overall trends: There were more than 425,000 alcohol-induced deaths during the study period. The annual percentage change in such deaths increased among both men and women, but rose significantly starting in 2012.
•Demographics: Starting in 2012, men experienced a 4.2% annual increase in alcohol-related deaths. From 2013-2016, women experienced an annual percentage increase of around 7%. American Indian and Alaska Native women experienced the highest increases over the 17-year study period.
•Causes: Alcoholic liver disease accounted for the majority of deaths among men and women, followed by mental or physical disorders due to alcohol and accidental poisoning.
Indigenous mortality and inequalities in Latin AmericaRamon Martinez
Latin America (LA) has experienced rapid improvements in life expectancy, reduced poverty, and infant mortality. Although social-economic, and health disparities between indigenous and non-indigenous remain.
Mortality information by ethnicity isn't available from most of LA countries.
The study aims to assess mortality inequalities between indigenous and non-indigenous in Brazil and Ecuador.
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CLizbethQuinonez813
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CANCER KNOWLEDGE AMONG HISPANICS
by
Capstone Paper submitted in partial fulfillment of the
requirements for the degree of
Doctor of Nursing Practice
June 03, 2021
Signature Faculty Reader Date
Signature Program Director Date
Acknowledgments
Abstract
Start typing here….
Key words:
2
Table of Contents
Acknowledgments X
Abstract X
Chapter One: Overview of the Problem of Interest X
Background Information X
Significance of the Problem X
Question Guiding Inquiry (PICO) X
Variables of the PICO question X
Summary X
Chapter Two: Review of the Literature/Evidence X
Methodology X
Sampling strategies X
Inclusion/Exclusion criteria X
Literature Review Findings X
Discussion X
Limitation of literature review. X
Conclusions of findings X
Potential practice change X
Summary X
Chapter Three: Theory and Model for Evidence-based Practice X
Theory X
Application to practice change X
Model for Evidence-Based Practice X
Application to practice change X
Summary X
Chapter Four: Project Management X
Project Purpose X
Project Management X
Organizational Readiness for Change X
Inter-professional Collaboration X
Risk Management Assessment X
Organizational Approval Process X
Use of Information Technology X
Materials Needed for Project X
Plans for Institutional Review Board Approval X
Summary X
Chapter Five: Plan for Project Implementation…………………………………………….X
Planned Project………………………………………………………………………X
High Level Goals for Population Health……………………………………………X
Planned Outcomes…………………………………………………………………..X
Plan for Project Evaluation X
Plan for Demographic Data Collection X
Plan for Outcome Data Collection and Measurement X
Plan for Evaluation Tool X
Plan for Data Analysis X
Plan for Data Management X
Summary……………………………………………………………………………..X
Chapter Six: Actual Implementation Process
Setting X
Participants X
Recruitment X
Implementation Process X
Plan Variation X
Summary X
Chapter Seven: Evaluation and Outcomes of the Practice Change X
Participant Demographicsf X
Table or Figure X X
Table or Figure X X
Outcome Findings X
Outcome One X
Table or Figure X X
Table or Figure X X
Summary X
Chapter Eight: Discussion and Summary………………………………………………….X
Recommendations for Site to Sustain Change X
Plans for Dissemination of Project X
Project Links to Health Promotion/Population Health X
Role of DNP-Prepared Nurse Leader in EBP X
Future Projects Related to Problem X
Implications for Policy and Advocacy at All Levels X
Final Conclusions X
References X
Appendix A: XXXXXX X
Appendix B: XXXXXX X
Appendix C: XXXXXX X
Appendix D: XXXXXX X
Appendix E: XXXXXX X
Appendix F: XXXXXX X
Appendix G: XXXXXX X
Chapter One: Overview of the Problem ...
However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a “lost generation” (36) whose future is less bright than those who preceded them.
Life Expectancy and Mortality Rates in the United States, 1959-2017Jim Bloyd, DrPH, MPH
Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.
Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.
Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.
Conclusions and Relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
Dr Yousef Elshrek is One co-authors in this study >>>> Global, regional, and...Univ. of Tripoli
Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Mortality and Causes of Death Collaborators*
Dr. Yousef Elshrek is Coauthors in this study
The rate of alcohol-related deaths has accelerated in recent years, according to a new analysis of U.S. mortality data between 2000-2016. Here's more:
•Overall trends: There were more than 425,000 alcohol-induced deaths during the study period. The annual percentage change in such deaths increased among both men and women, but rose significantly starting in 2012.
•Demographics: Starting in 2012, men experienced a 4.2% annual increase in alcohol-related deaths. From 2013-2016, women experienced an annual percentage increase of around 7%. American Indian and Alaska Native women experienced the highest increases over the 17-year study period.
•Causes: Alcoholic liver disease accounted for the majority of deaths among men and women, followed by mental or physical disorders due to alcohol and accidental poisoning.
Indigenous mortality and inequalities in Latin AmericaRamon Martinez
Latin America (LA) has experienced rapid improvements in life expectancy, reduced poverty, and infant mortality. Although social-economic, and health disparities between indigenous and non-indigenous remain.
Mortality information by ethnicity isn't available from most of LA countries.
The study aims to assess mortality inequalities between indigenous and non-indigenous in Brazil and Ecuador.
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CLizbethQuinonez813
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CANCER KNOWLEDGE AMONG HISPANICS
by
Capstone Paper submitted in partial fulfillment of the
requirements for the degree of
Doctor of Nursing Practice
June 03, 2021
Signature Faculty Reader Date
Signature Program Director Date
Acknowledgments
Abstract
Start typing here….
Key words:
2
Table of Contents
Acknowledgments X
Abstract X
Chapter One: Overview of the Problem of Interest X
Background Information X
Significance of the Problem X
Question Guiding Inquiry (PICO) X
Variables of the PICO question X
Summary X
Chapter Two: Review of the Literature/Evidence X
Methodology X
Sampling strategies X
Inclusion/Exclusion criteria X
Literature Review Findings X
Discussion X
Limitation of literature review. X
Conclusions of findings X
Potential practice change X
Summary X
Chapter Three: Theory and Model for Evidence-based Practice X
Theory X
Application to practice change X
Model for Evidence-Based Practice X
Application to practice change X
Summary X
Chapter Four: Project Management X
Project Purpose X
Project Management X
Organizational Readiness for Change X
Inter-professional Collaboration X
Risk Management Assessment X
Organizational Approval Process X
Use of Information Technology X
Materials Needed for Project X
Plans for Institutional Review Board Approval X
Summary X
Chapter Five: Plan for Project Implementation…………………………………………….X
Planned Project………………………………………………………………………X
High Level Goals for Population Health……………………………………………X
Planned Outcomes…………………………………………………………………..X
Plan for Project Evaluation X
Plan for Demographic Data Collection X
Plan for Outcome Data Collection and Measurement X
Plan for Evaluation Tool X
Plan for Data Analysis X
Plan for Data Management X
Summary……………………………………………………………………………..X
Chapter Six: Actual Implementation Process
Setting X
Participants X
Recruitment X
Implementation Process X
Plan Variation X
Summary X
Chapter Seven: Evaluation and Outcomes of the Practice Change X
Participant Demographicsf X
Table or Figure X X
Table or Figure X X
Outcome Findings X
Outcome One X
Table or Figure X X
Table or Figure X X
Summary X
Chapter Eight: Discussion and Summary………………………………………………….X
Recommendations for Site to Sustain Change X
Plans for Dissemination of Project X
Project Links to Health Promotion/Population Health X
Role of DNP-Prepared Nurse Leader in EBP X
Future Projects Related to Problem X
Implications for Policy and Advocacy at All Levels X
Final Conclusions X
References X
Appendix A: XXXXXX X
Appendix B: XXXXXX X
Appendix C: XXXXXX X
Appendix D: XXXXXX X
Appendix E: XXXXXX X
Appendix F: XXXXXX X
Appendix G: XXXXXX X
Chapter One: Overview of the Problem ...
Please go to the New York State Health Dept.httpswww.health.docxjanekahananbw
Please go to the New York State Health Dept.
https://www.health.ny.gov/statistics/vital_statistics/2013/
Census Bureau
http://quickfacts.census.gov/qfd/states/36000.html
Before you start the specific assignment you may want to examine the information available.
Area I Area II Source of
Data
Population
Birth Rate per 1000
Mortality Rate per 100,000
Major Causes of Death
Top 3 in order
Level of Education
% high school grad
% college grad
% adv
Level of Income
Median household in $
Racial/Ethnic composition
Use data from New York State Health Dept. and the Census Bureau to compare two communities of your choice. You may also want to try the Centers for Disease Prevention and Control CDC at www.cdc.gov. Another strategy to get information is to "google" your topic e.g. White Plains, New York demographic and mortality data.
The communities may be counties, cities, states or any combination of the two: eg. Westchester and Rockland, White Plains and Yonkers, Overall Westchester and White Plains etc., Bronx and NYC, Brooklyn and Queens, Brooklyn and Statewide or Citywide, New York State and North Carolina etc. HINT Before you finalize the choice of community make sure that you are able to locate material on it.
Please put the data in a table see above. Write a narrative -- a paragraph in length comparing the two areas. (I would suggest that online students prepare a paper copy for themselves). Be sure that your name appears on the report itself if you submit it as an attachment. Also, check that your data clearly indicates whether the number is a number, rate or percentage. If figure is a rate indicate the relevant population e.g. per 1,000, 10,000, per 100,000. See text for more information on rates.
You may attach map(s) and data table from NY State Health Dept. and the Census Bureau to your report. However, the table must report the data.
Grading-- A Complete report and comparison of two areas--Thoughtful comparison of the two areas. Sources of information ( for each item of information) clearly indicated. Provides a useful profile of socio-economic and health profile for areas selected.
B/B+ Good chart, good comparison. Sources of information clearly indicated.
C Comparison missing items, narrative comparison brief
D Assignment begun but not substantially completed
F Did not do assignment
Discussion Folder Open
Email your answer to me in the course email before 6 p.m on the due date.
Post your answer here after 6 p.m on the due date.
Article on Puerto Rican in US
See article. Has data from CDC National Center for Health Statistics
Health of Hispanic Adults: US 2010-2014
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
CDC A-Z Index
MENU
CDC A-Z
SEARCH
National Center for Health Statistics
Publications and Information Products
Data Briefs
Health of Hispanic Adults.
Overview of public health issues in the Metro Atlanta area, presented by the Atlanta Regional Commission's Research and Analytics Group and Neighborhood Nexus. Topics include COVID-19, homicide, opioids, maternal health and County Health Rankings status.
Predictive analysis WHO's life expectancy dataset using Tableau data visualis...Tarun Swarup
Performed predictive analysis on global Life expectancy dataset (WHO) to analyze the vital factors affecting human health and other societal risks demographically.
Designed a visual dashboard to identify intrinsic patterns in different factors and extract valuable insights to predict life expectancy accordingly.
▪ Infant Death Rate almost reduced by 40% in the last two decades.
▪ Overall adult mortality rate turned down by almost 17% in the previous years.
Shocking study in JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION of 1.4 billion person-years documenting rising death rates among middle aged whites, amounting to over 600,000 lives lost due to alcoholism, drug overdoses and suicides
Diversity and Cultural Competency in Health Care Je.docxShiraPrater50
Diversity and Cultural
Competency in Health Care
Jean Gordon, RN, DBA
LEARNING OUTCOMES
After completing this chapter, the student should be able to:
☛ Define diversity.
☛ Define cultural competency.
☛ Define diversity management.
☛ Understand why changes in U.S. demographics affect the health care industry.
OVERVIEW
Demographics of the U.S. population have changed dramatically in the
past three decades. These changes directly impact the health care indus-
try in regard to the patients we serve and our workforce. By 2050, the term
“minority” will take on a new meaning. According to the U.S. Census Bureau,
by midcentury the white, non-Hispanic population will comprise less than
50 percent of the nation’s population. As such, the health care industry needs
to change and adopt new ways to meet the diverse needs of our current and
future patients and employees.
The American Heritage Dictionary of the English Language (4th ed.) defines
diversity as: “(1) the fact or quality of being diverse; difference, and (2) a point
in which things differ.” Dreachslin (1998) provided us with a more specific def-
inition of diversity. She defined diversity as “the full range of human similari-
ties and differences in group affiliation including gender, race/ethnicity, social
class, role within an organization, age, religion, sexual orientation, physi-
cal ability, and other group identities” (p. 813). For our discussions, we will
focus on the following diversity characteristics: (1) race/ethnicity, (2) age, and
(3) gender.
This chapter is presented in three parts. First, we discuss the chang-
ing demographics of the nation’s population. Second, we examine how these
changes are affecting the delivery of health services from both the patient’s
and employee’s perspectives. Because diversity challenges faced by the health
care industry are not limited to quality-of-care and access-to-care issues, in
part three of our discussions we explore how these changes will affect the
health services workforce, and more specifically the current and future leader-
ship within the industry.
15
CHAPTER 2
9781284087062_CH02_PASS02.indd 15 17/02/15 6:10 PM
CHANGING UNITED STATES POPULATION
There is no doubt that the demographic profile of the U.S. population has
undergone significant changes within the past 10 years regarding age, gender,
and ethnicity (see Table 2–1 ).
Data from the 2010 Census provide insights to our racially and ethnically
diverse nation (Humes, Jones, & Ramirez, 2011). According to the 2010 Cen-
sus, 308.7 million people resided in the United States on April 1, 2010—an
increase of 27.3 million people, or 9.7 percent, between 2000 and 2010. The
vast majority of the growth in the total population came from increases in
those who reported their race(s) as something other than White alone and
those who reported their ethnicity as Hispanic or Latino. For the first time in ...
Diversity and Cultural Competency in Health Care Je.docxAASTHA76
Diversity and Cultural
Competency in Health Care
Jean Gordon, RN, DBA
LEARNING OUTCOMES
After completing this chapter, the student should be able to:
☛ Define diversity.
☛ Define cultural competency.
☛ Define diversity management.
☛ Understand why changes in U.S. demographics affect the health care industry.
OVERVIEW
Demographics of the U.S. population have changed dramatically in the
past three decades. These changes directly impact the health care indus-
try in regard to the patients we serve and our workforce. By 2050, the term
“minority” will take on a new meaning. According to the U.S. Census Bureau,
by midcentury the white, non-Hispanic population will comprise less than
50 percent of the nation’s population. As such, the health care industry needs
to change and adopt new ways to meet the diverse needs of our current and
future patients and employees.
The American Heritage Dictionary of the English Language (4th ed.) defines
diversity as: “(1) the fact or quality of being diverse; difference, and (2) a point
in which things differ.” Dreachslin (1998) provided us with a more specific def-
inition of diversity. She defined diversity as “the full range of human similari-
ties and differences in group affiliation including gender, race/ethnicity, social
class, role within an organization, age, religion, sexual orientation, physi-
cal ability, and other group identities” (p. 813). For our discussions, we will
focus on the following diversity characteristics: (1) race/ethnicity, (2) age, and
(3) gender.
This chapter is presented in three parts. First, we discuss the chang-
ing demographics of the nation’s population. Second, we examine how these
changes are affecting the delivery of health services from both the patient’s
and employee’s perspectives. Because diversity challenges faced by the health
care industry are not limited to quality-of-care and access-to-care issues, in
part three of our discussions we explore how these changes will affect the
health services workforce, and more specifically the current and future leader-
ship within the industry.
15
CHAPTER 2
9781284087062_CH02_PASS02.indd 15 17/02/15 6:10 PM
CHANGING UNITED STATES POPULATION
There is no doubt that the demographic profile of the U.S. population has
undergone significant changes within the past 10 years regarding age, gender,
and ethnicity (see Table 2–1 ).
Data from the 2010 Census provide insights to our racially and ethnically
diverse nation (Humes, Jones, & Ramirez, 2011). According to the 2010 Cen-
sus, 308.7 million people resided in the United States on April 1, 2010—an
increase of 27.3 million people, or 9.7 percent, between 2000 and 2010. The
vast majority of the growth in the total population came from increases in
those who reported their race(s) as something other than White alone and
those who reported their ethnicity as Hispanic or Latino. For the first time in.
A new data brief reports that deaths from drug abuse among millennials has increased by 400% in the past 20 years. The opioid crisis partly explains the increase, but millennials also face other problems, including high living costs. Here’s more on what the report calls “deaths of despair”:
•Drug deaths: The number of deaths among those in their 20s and 30s went up by 108% between 2007 and 2017.
•Alcohol-related deaths: These deaths in those aged 18-34 went up by nearly 70% between 2007 and 2017, and nearly doubled since 1999.
•Suicides: Between 2011 and 2016, suicide was the second leading cause of death among those aged 15-34, and the following year, suicide rates across all ages increased by 4%.
Overweight and Medical Condition in US : 3 Factors that affect Childhood obe...Sumit Roy
Obesity and the risk of being overweight, leads to not only chronic medical condition, but also makes an individual susceptible to many kinds of conditions. The paper from American heart foundation. shares numbers that are quite frightning
Paho social inequities in the americas 2001 engRamon Martinez
Dr. Roses, PAHO Director, presentation on Social Inequalities in health in the Region of the Americas.
PAHO's Regional Health Observatory (RHO
Pan American health Organization (PAHO)
6 Pagesewly appointed Police Chief Alexandra Delatorre of the An.docxGrazynaBroyles24
6 Pages
ewly appointed Police Chief Alexandra Delatorre of the Anytown Police Department (APD) has been attending several town and city council meetings whereby she has heard numerous complaints about the increase in armed robberies being committed by the local transients (homeless people) in and near the Anytown Gallery Shopping Mall. Chief Delatorre checked with the crime analysis unit of the department to obtain information on the crime statistics for robberies in the area of the shopping mall. The crime analysis unit determined that there was 75% increase in the number of robberies between 2009 and 2011. The chief attended a meeting with the shopping mall executives and learned that there had been a steady increase in the number of businesses leaving the mall, which served as major sources for employment and revenue for the city.
One week ago, Chief Delatorre drove to the shopping mall one evening at 9:30 p.m., before the mall was about to close, and discovered that several sections of the subterranean multilevel parking lot had poor lighting and no security gate that secured the parking area, and the guard shack was in an obscure portion of the first level and appeared to not have been used for quite some time. She also found what appeared to be small “camps” of blankets, trash, old and dirty clothes, and metal shopping carts that belonged to different local grocery stores in the far corners of the parking lot on the lower two levels. There was also a very strong odor of urine in the area of the “camps.”
Chief Delatorre has convened you and your team to make recommendations on addressing the problem of the robberies at the shopping mall. She wants to implement a program using the community-oriented policing (COP) philosophy. She has several specific areas that need to be considered for the COP program to reduce or even eliminate the robberies at the shopping mall. She would like to give the program a name. You are to compose a written memo that addresses the following::
Assignment Guidelines
Address the following in a strategic plan of 6–10 pages:
What social forces exist within the above assignment scenario? Describe and explain.
Preparation
How should the department prepare for the program, and who should be involved? Explain.
What types of social or special interest groups should be included? Why are they important to this program? How might they affect the final product?
Gathering information
What information (data, facts, statistics, etc.) would need to be gathered to start the program design? Explain.
Consider at least race, age, gender, social class, and public opinion in your response.
Organizational review
How will this COP program impact the daily operations of the APD? Explain.
How will the program affect the organizational culture of the department? Explain.
The community
How will the community members be involved? Explain.
How will the program extend to members of a multicultural community?
Consider religion, ethnicity, cus.
6 pages which reach all of requiements below hereAn essay inclu.docxGrazynaBroyles24
6 pages which reach all of requiements below here:
An essay includes 3 articles from mine.
The main one is the attachment with 2 others to support it that two links here.
Should follow all of details from intruction.
Contact me when you are available.
.
More Related Content
Similar to the bmj BMJ 2021;373n1343 doi 10.1136bmj.n1343 1R E
Please go to the New York State Health Dept.httpswww.health.docxjanekahananbw
Please go to the New York State Health Dept.
https://www.health.ny.gov/statistics/vital_statistics/2013/
Census Bureau
http://quickfacts.census.gov/qfd/states/36000.html
Before you start the specific assignment you may want to examine the information available.
Area I Area II Source of
Data
Population
Birth Rate per 1000
Mortality Rate per 100,000
Major Causes of Death
Top 3 in order
Level of Education
% high school grad
% college grad
% adv
Level of Income
Median household in $
Racial/Ethnic composition
Use data from New York State Health Dept. and the Census Bureau to compare two communities of your choice. You may also want to try the Centers for Disease Prevention and Control CDC at www.cdc.gov. Another strategy to get information is to "google" your topic e.g. White Plains, New York demographic and mortality data.
The communities may be counties, cities, states or any combination of the two: eg. Westchester and Rockland, White Plains and Yonkers, Overall Westchester and White Plains etc., Bronx and NYC, Brooklyn and Queens, Brooklyn and Statewide or Citywide, New York State and North Carolina etc. HINT Before you finalize the choice of community make sure that you are able to locate material on it.
Please put the data in a table see above. Write a narrative -- a paragraph in length comparing the two areas. (I would suggest that online students prepare a paper copy for themselves). Be sure that your name appears on the report itself if you submit it as an attachment. Also, check that your data clearly indicates whether the number is a number, rate or percentage. If figure is a rate indicate the relevant population e.g. per 1,000, 10,000, per 100,000. See text for more information on rates.
You may attach map(s) and data table from NY State Health Dept. and the Census Bureau to your report. However, the table must report the data.
Grading-- A Complete report and comparison of two areas--Thoughtful comparison of the two areas. Sources of information ( for each item of information) clearly indicated. Provides a useful profile of socio-economic and health profile for areas selected.
B/B+ Good chart, good comparison. Sources of information clearly indicated.
C Comparison missing items, narrative comparison brief
D Assignment begun but not substantially completed
F Did not do assignment
Discussion Folder Open
Email your answer to me in the course email before 6 p.m on the due date.
Post your answer here after 6 p.m on the due date.
Article on Puerto Rican in US
See article. Has data from CDC National Center for Health Statistics
Health of Hispanic Adults: US 2010-2014
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
CDC A-Z Index
MENU
CDC A-Z
SEARCH
National Center for Health Statistics
Publications and Information Products
Data Briefs
Health of Hispanic Adults.
Overview of public health issues in the Metro Atlanta area, presented by the Atlanta Regional Commission's Research and Analytics Group and Neighborhood Nexus. Topics include COVID-19, homicide, opioids, maternal health and County Health Rankings status.
Predictive analysis WHO's life expectancy dataset using Tableau data visualis...Tarun Swarup
Performed predictive analysis on global Life expectancy dataset (WHO) to analyze the vital factors affecting human health and other societal risks demographically.
Designed a visual dashboard to identify intrinsic patterns in different factors and extract valuable insights to predict life expectancy accordingly.
▪ Infant Death Rate almost reduced by 40% in the last two decades.
▪ Overall adult mortality rate turned down by almost 17% in the previous years.
Shocking study in JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION of 1.4 billion person-years documenting rising death rates among middle aged whites, amounting to over 600,000 lives lost due to alcoholism, drug overdoses and suicides
Diversity and Cultural Competency in Health Care Je.docxShiraPrater50
Diversity and Cultural
Competency in Health Care
Jean Gordon, RN, DBA
LEARNING OUTCOMES
After completing this chapter, the student should be able to:
☛ Define diversity.
☛ Define cultural competency.
☛ Define diversity management.
☛ Understand why changes in U.S. demographics affect the health care industry.
OVERVIEW
Demographics of the U.S. population have changed dramatically in the
past three decades. These changes directly impact the health care indus-
try in regard to the patients we serve and our workforce. By 2050, the term
“minority” will take on a new meaning. According to the U.S. Census Bureau,
by midcentury the white, non-Hispanic population will comprise less than
50 percent of the nation’s population. As such, the health care industry needs
to change and adopt new ways to meet the diverse needs of our current and
future patients and employees.
The American Heritage Dictionary of the English Language (4th ed.) defines
diversity as: “(1) the fact or quality of being diverse; difference, and (2) a point
in which things differ.” Dreachslin (1998) provided us with a more specific def-
inition of diversity. She defined diversity as “the full range of human similari-
ties and differences in group affiliation including gender, race/ethnicity, social
class, role within an organization, age, religion, sexual orientation, physi-
cal ability, and other group identities” (p. 813). For our discussions, we will
focus on the following diversity characteristics: (1) race/ethnicity, (2) age, and
(3) gender.
This chapter is presented in three parts. First, we discuss the chang-
ing demographics of the nation’s population. Second, we examine how these
changes are affecting the delivery of health services from both the patient’s
and employee’s perspectives. Because diversity challenges faced by the health
care industry are not limited to quality-of-care and access-to-care issues, in
part three of our discussions we explore how these changes will affect the
health services workforce, and more specifically the current and future leader-
ship within the industry.
15
CHAPTER 2
9781284087062_CH02_PASS02.indd 15 17/02/15 6:10 PM
CHANGING UNITED STATES POPULATION
There is no doubt that the demographic profile of the U.S. population has
undergone significant changes within the past 10 years regarding age, gender,
and ethnicity (see Table 2–1 ).
Data from the 2010 Census provide insights to our racially and ethnically
diverse nation (Humes, Jones, & Ramirez, 2011). According to the 2010 Cen-
sus, 308.7 million people resided in the United States on April 1, 2010—an
increase of 27.3 million people, or 9.7 percent, between 2000 and 2010. The
vast majority of the growth in the total population came from increases in
those who reported their race(s) as something other than White alone and
those who reported their ethnicity as Hispanic or Latino. For the first time in ...
Diversity and Cultural Competency in Health Care Je.docxAASTHA76
Diversity and Cultural
Competency in Health Care
Jean Gordon, RN, DBA
LEARNING OUTCOMES
After completing this chapter, the student should be able to:
☛ Define diversity.
☛ Define cultural competency.
☛ Define diversity management.
☛ Understand why changes in U.S. demographics affect the health care industry.
OVERVIEW
Demographics of the U.S. population have changed dramatically in the
past three decades. These changes directly impact the health care indus-
try in regard to the patients we serve and our workforce. By 2050, the term
“minority” will take on a new meaning. According to the U.S. Census Bureau,
by midcentury the white, non-Hispanic population will comprise less than
50 percent of the nation’s population. As such, the health care industry needs
to change and adopt new ways to meet the diverse needs of our current and
future patients and employees.
The American Heritage Dictionary of the English Language (4th ed.) defines
diversity as: “(1) the fact or quality of being diverse; difference, and (2) a point
in which things differ.” Dreachslin (1998) provided us with a more specific def-
inition of diversity. She defined diversity as “the full range of human similari-
ties and differences in group affiliation including gender, race/ethnicity, social
class, role within an organization, age, religion, sexual orientation, physi-
cal ability, and other group identities” (p. 813). For our discussions, we will
focus on the following diversity characteristics: (1) race/ethnicity, (2) age, and
(3) gender.
This chapter is presented in three parts. First, we discuss the chang-
ing demographics of the nation’s population. Second, we examine how these
changes are affecting the delivery of health services from both the patient’s
and employee’s perspectives. Because diversity challenges faced by the health
care industry are not limited to quality-of-care and access-to-care issues, in
part three of our discussions we explore how these changes will affect the
health services workforce, and more specifically the current and future leader-
ship within the industry.
15
CHAPTER 2
9781284087062_CH02_PASS02.indd 15 17/02/15 6:10 PM
CHANGING UNITED STATES POPULATION
There is no doubt that the demographic profile of the U.S. population has
undergone significant changes within the past 10 years regarding age, gender,
and ethnicity (see Table 2–1 ).
Data from the 2010 Census provide insights to our racially and ethnically
diverse nation (Humes, Jones, & Ramirez, 2011). According to the 2010 Cen-
sus, 308.7 million people resided in the United States on April 1, 2010—an
increase of 27.3 million people, or 9.7 percent, between 2000 and 2010. The
vast majority of the growth in the total population came from increases in
those who reported their race(s) as something other than White alone and
those who reported their ethnicity as Hispanic or Latino. For the first time in.
A new data brief reports that deaths from drug abuse among millennials has increased by 400% in the past 20 years. The opioid crisis partly explains the increase, but millennials also face other problems, including high living costs. Here’s more on what the report calls “deaths of despair”:
•Drug deaths: The number of deaths among those in their 20s and 30s went up by 108% between 2007 and 2017.
•Alcohol-related deaths: These deaths in those aged 18-34 went up by nearly 70% between 2007 and 2017, and nearly doubled since 1999.
•Suicides: Between 2011 and 2016, suicide was the second leading cause of death among those aged 15-34, and the following year, suicide rates across all ages increased by 4%.
Overweight and Medical Condition in US : 3 Factors that affect Childhood obe...Sumit Roy
Obesity and the risk of being overweight, leads to not only chronic medical condition, but also makes an individual susceptible to many kinds of conditions. The paper from American heart foundation. shares numbers that are quite frightning
Paho social inequities in the americas 2001 engRamon Martinez
Dr. Roses, PAHO Director, presentation on Social Inequalities in health in the Region of the Americas.
PAHO's Regional Health Observatory (RHO
Pan American health Organization (PAHO)
6 Pagesewly appointed Police Chief Alexandra Delatorre of the An.docxGrazynaBroyles24
6 Pages
ewly appointed Police Chief Alexandra Delatorre of the Anytown Police Department (APD) has been attending several town and city council meetings whereby she has heard numerous complaints about the increase in armed robberies being committed by the local transients (homeless people) in and near the Anytown Gallery Shopping Mall. Chief Delatorre checked with the crime analysis unit of the department to obtain information on the crime statistics for robberies in the area of the shopping mall. The crime analysis unit determined that there was 75% increase in the number of robberies between 2009 and 2011. The chief attended a meeting with the shopping mall executives and learned that there had been a steady increase in the number of businesses leaving the mall, which served as major sources for employment and revenue for the city.
One week ago, Chief Delatorre drove to the shopping mall one evening at 9:30 p.m., before the mall was about to close, and discovered that several sections of the subterranean multilevel parking lot had poor lighting and no security gate that secured the parking area, and the guard shack was in an obscure portion of the first level and appeared to not have been used for quite some time. She also found what appeared to be small “camps” of blankets, trash, old and dirty clothes, and metal shopping carts that belonged to different local grocery stores in the far corners of the parking lot on the lower two levels. There was also a very strong odor of urine in the area of the “camps.”
Chief Delatorre has convened you and your team to make recommendations on addressing the problem of the robberies at the shopping mall. She wants to implement a program using the community-oriented policing (COP) philosophy. She has several specific areas that need to be considered for the COP program to reduce or even eliminate the robberies at the shopping mall. She would like to give the program a name. You are to compose a written memo that addresses the following::
Assignment Guidelines
Address the following in a strategic plan of 6–10 pages:
What social forces exist within the above assignment scenario? Describe and explain.
Preparation
How should the department prepare for the program, and who should be involved? Explain.
What types of social or special interest groups should be included? Why are they important to this program? How might they affect the final product?
Gathering information
What information (data, facts, statistics, etc.) would need to be gathered to start the program design? Explain.
Consider at least race, age, gender, social class, and public opinion in your response.
Organizational review
How will this COP program impact the daily operations of the APD? Explain.
How will the program affect the organizational culture of the department? Explain.
The community
How will the community members be involved? Explain.
How will the program extend to members of a multicultural community?
Consider religion, ethnicity, cus.
6 pages which reach all of requiements below hereAn essay inclu.docxGrazynaBroyles24
6 pages which reach all of requiements below here:
An essay includes 3 articles from mine.
The main one is the attachment with 2 others to support it that two links here.
Should follow all of details from intruction.
Contact me when you are available.
.
54w9Performing Effective Project Monitoring and Risk Management.docxGrazynaBroyles24
54/w9
Performing Effective Project Monitoring and Risk Management
Imagine that you are employed as an IT project manager by a prestigious coffeemaker organization. This organization operates many coffee shops within the region and would like to promote its brand by creating a mobile application that will provide its customers with the ability to view the nearest coffee shop location within their geographical area.
As a member of the software development team, you estimate a total project cost of $150,000. You have designated control points to measure project progress. At control point 2, the following data is available:
Budget Cost of Work Performed
$ 24,000
Actual Cost of Work Performed
$ 27,500
There are various stakeholders that are interested in the progress of the project. These stakeholders include the marketing management team (internal customers), software designers, programmers, testers, and upper management. The software development team has attempted to release a mobile application of this magnitude in the past; however, lack of sponsorship, mobile development expertise, and technical infrastructure has limited the team’s success.
Write a four to six (4-6) page paper in which you:
Identify at least four (4) attributes of the mobile application development project that can be measured and controlled and evaluate how each is a critical factor for the success of the project.
Generate a project plan summary of the various project milestones. Develop a WBS that details work packages required to complete project scope.
Develop a workflow model that can be used to inspect and detect defects during the acceptance of this mobile product through the use of graphical tools in Microsoft Word or Visio, or an open source alternative such as Dia. Note: The graphically depicted solution is not included in the required page length.
Describe how the defects detected during the acceptance of the mobile application should be reported and explain the circumstances in which a defect may not require reporting.
Analyze the communication needs of the different project stakeholders. Explain the types of project status reports that would be useful to each.
Compute the cost variance, schedule variance, cost performance index, schedule performance index, and estimated actual cost using the information presented at control point 2. Interpret the project schedule and budget status from the calculations.
Explain how work package, binary tracking, and earned valued reporting can be used effectively during the maintenance phase of the software life cycle if various change requests may be assigned to individuals and processed on an individual basis.
Develop a risk register that will document all of the estimated risks. Assign one (1) risk management technique for each risk and explain the basis for your selection.
Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.
Your ass.
5I need a fiive page paper with title page, reference page in APA fo.docxGrazynaBroyles24
5I need a fiive page paper with title page, reference page in APA format , and cited properly. The title is Ethic Group Evaluation. You will be evaluating the ethinic group Black Americans. You will examine the history of this group in the United States, including the following: Immigration, Contact with other ethinic groups, Assimilation or pluralism, and its connection to black americans contact with other ethinic groups,conflict with other ethinic groups. Provide an example of a widely - held myth or misconception about Blacks. How do we know this is a myth? Why is this myth so differcult to abandon?
.
6 pages paper for International relations class Knowledgeable Econo.docxGrazynaBroyles24
6 pages paper for International relations class: Knowledgeable Economy (global political economy)
Response paper, pay attention to own ideas and thoughts
MLA style, Doube Space
Only PPTs and Textbooks can be used, it means that all of outside materials cannot be used(I will send them to you by email)
.
50 words minimum This weeks audio is very informative but o.docxGrazynaBroyles24
50 words minimum
This week's audio is very informative but one point stuck out to me the most. I found it interesting that a big issue is the struggle to have communication between agencies, municipalities, and federally. It brought up that an example of this is communication through radio. Each individual has completely different equipment which makes communication with anyone outside of the agency via radio impossible. You would think with today's technology they would find away to maintain easy communication between all emergency related organizations. This would ensure that they all are on the same page and can have effective cooperation during big emergencies such as 9/11. What are the methods of communication that currently exist and how do they help different emergency related agencies stay connected?
The first Amendment is a so important to our way of life so when it is abused and people die should the media be held responsible? There are attempts to hold gunmakers liable for gun deaths so is it the same with media when they provide inaccurate information that may then cause violent protest?
Given the perpetual imbalance between funding and needs in emergency services and criminal justice, what are possible sources of funding for a emergency management training, equipment, and sustainability?
The Department of Homeland Security and FEMA as well as various state and federal grants can be requested to assist in funding the various state and local agencies in their Emergency Management related maintenance and training. The equipment and personnel are expensive to have and to keep current in training so any help with grants and donations is always appreciated. Could local fund drives help?
Do you support a national standard for communication equipment for emergency management? If not, why not? How would agencies pay for interoperability communications?
.
500 word discussion on the passage to answer question at the botto.docxGrazynaBroyles24
500 word discussion on the passage to answer question at the bottom
The authors of our text have suggested that there are no obvious or absolute "priority relations" among the six basic moral values. This means that in any conflicts posed by applying different values to cases, there are no general rules for deciding which values are more important. We have to take each case on its merits.
They might be right about this. It's a commonly held perspective on moral values.
In the Lecture I discussed the relation between Justice and Compassion.
We sometimes encounter conflicts between these two values, and I think the story of Robin Hood is the classic tale of such conflict. Robin Hood acted compassionately in robbing from the rich to give to the poor.
Now I'm assuming that the rich deserved their wealth, and did not acquire it unjustly. That is, I am supposing that Robin Hood was not moved by his sense of justice, on this count (but see below). This is a controversial assumption, for there are those who would argue that the rich (or at least, the inordinately rich) could not have become that rich without transgressing some moral principle. But I will make this assumption in order to simplify the discussion. So let us assume that the rich people Robin Hood took from had not made their fortune unjustly. But even this does not mean that Robin Hood was wrong to take from them. It could be, from the perspective of some sort of duty theory, that the rich had a duty to take care of the poor, and they had failed in this moral duty. So Robin Hood was correcting their immoral behavior (not in obtaining the wealth, but in not dispensing it as they ought to). He was moved by the suffering of the poor, and the immorality of the rich in not responding to this suffering, which makes him a compassionate and moral hero. (By the way, I am not committed to this view--I am mentioning it to show you that there is much more to be discussed here than might meet the eye of our 21st. century, prior to philosophical reflection.
The questions, therefore, are:
Is Robin Hood acting justly, or unjustly but because he is moved by compassion?
Could a compassionate Robin Hood ever be
right
to violate the rules of justice in order to alleviate suffering?
With regard to the second of these, I assume that the standard answer in our 21st. Century culture would be: No; justice should always win in conflicts with compassion. So there is at least one absolute priority relation between two of the basic moral values in the set.
Do you agree? Why or why not?
.
5. An electric motor accomplishes what task[removed]convert.docxGrazynaBroyles24
5.
An electric motor accomplishes what task?
[removed]
converts chemical energy into mechanical energy
[removed]
converts electrical energy into electromagnetic energy
[removed]
converts electrical energy into mechanical energy
[removed]
converts mechanical energy into chemical energy
[removed]
converts mechanical energy into electrical energy
The next five questions refer to these electric meters:
15.
How much electricity was used during the month of June?
[removed]
2813 kwh
[removed]
2582 kwh
[removed]
3011 kwh
[removed]
2903 kwh
[removed]
2744 kwh
17.
How much would this energy cost the consumer? (assume the average rate of $0.07 per kwh)
[removed]
$203.00
[removed]
$210.77
[removed]
$196.91
[removed]
$188.90
[removed]
$176.43
18.
What was the meter reading on June 1?
[removed]
59,301
[removed]
58,300
[removed]
58,410
[removed]
69,411
[removed]
58,310
19.
What was the meter reading on July 1?
[removed]
61,134
[removed]
61,132
[removed]
61,234
[removed]
61,123
[removed]
61,223
20.
A piece of iron can be made into a permanent magnet by stroking it with a strong magnet.
[removed]
true
[removed]
false
10.
If the frequency of a wave is 5 Hz, how many waves will pass by a stationary object in 1 minute?
[removed]
1/5
[removed]
5
[removed]
300
[removed]
60
[removed]
1/300
11.
A submarine captain wishes to know how far away an undersea cliff face is, so he sends out a SONAR signal. After 0.80 seconds, he receives the echo. How far away is the cliff face?
[removed]
1500 m
[removed]
1200 m
[removed]
600 m
[removed]
3000 m
[removed]
2400 m
Use this figure to answer the next 3 questions:
12.
On the diagram, which letter represents the amplitude?
[removed]
A
[removed]
B
[removed]
C
[removed]
D
[removed]
E
13.
Which of the letters represents the wavelength?
[removed]
A
[removed]
B
[removed]
C
[removed]
D
[removed]
E
14.
Which position represents the trough?
[removed]
A
[removed]
B
[removed]
C
[removed]
D
[removed]
E
1.
If a star is moving away from Earth at a high speed, which of the following would astronomers observe?
[removed]
The star's spectrum would not be shifted at all.
[removed]
The star's spectrum would be shifted towards red.
[removed]
The star's spectrum would be shifted towards blue.
[removed]
There is not enough information given to determine.
5.
The visible spectrum is made of what types of light?
[removed]
red, orange, yellow, green, blue, violet
[removed]
infrared, red, orange, green, blue, ultraviolet
[removed]
red, orange, yellow, green, blue, ultraviolet
[removed]
radio, infrared, colored light, ultraviolet, x-rays, gamma rays
10.
Which of the following has the most energy?
[removed]
x-rays
[removed]
ultraviolet
[removed]
visible light
[removed]
gamma rays
[removed]
infrared
11.
Which of the following best describes the dual nature of light?
[removed]
Light can be thought of as visible colors or as invisible colors.
[removed]
Light can be thought of as being white light or a combinat.
5.4 - Commercial Air Travel during the 1950’s – 1960’sIn this .docxGrazynaBroyles24
5.4 - Commercial Air Travel during the 1950’s – 1960’s
In this discussion activity, address the following:
Commercial air travel became routine during the late fifties and early sixties. Discuss the improvements made by the airlines during this time period, including the introduction of jet airliners and extensive route systems.
Why did commercial air travel become so successful during this time?
The primary posting should be approximately 100 words.
.
500 wordsAPA FormatScenarioYou are a probation officer a.docxGrazynaBroyles24
500 words
APA Format
Scenario
You are a probation officer and have a client, Paul Rosen, who was recently released from prison and is a registered sex offender. One of the obligations of a probationer is to keep in close contact with his probation officer. This particular probationer failed to maintain contact with you for a period of 4 months. During your effort to find Paul Rosen, you find out that Paul was involved with a woman who has three children, ages 6, 9, and 14. You feel compelled to contact this woman and find out whether she knew that Paul was a registered sex offender who is out of prison on probation. During the conversation, she was appreciative that you had concerns but explained that Paul told her that he was involved with a 16-year-old, but that the girl had lied to him about her age. She said his conviction was the fault of the girl's parents, who convinced the daughter to press charges as a way to keep him away from her. She said it was not a big deal because the girl lied to Paul about her age. During your conversation with the woman, you feel compelled to tell her about John's past of molesting two girls, ages 4 and 7.
Analyze this scenario, and discuss the following:
Describe how you would handle this situation using normative ethics?
In applied ethics, you do not deal with the facts of individual cases. You focus on applying ethical rules to a class of cases. Describe the class or type of case represented here.
After determining the type of case, describe the professional code of ethics that may apply to this type of case?
Based on the rule you would apply to this type of case, what should you do as a probation officer in this type of case?
.
500 words- no references. Must be original, no plagiarism.docxGrazynaBroyles24
500 words- no references. Must be original, no plagiarism
Scenario D
Communities Organized for relational Power in Action (COPA) - Health Care for All
COPA has organized Monterey County to pilot a health care program that provides prescriptions, lab work and radiology.
COPA will organize to ensure that this pilot program becomes a permanent program to provide needed health care services to undocumented adults in Monterey County.
-
Develop core of 30 COPA leaders as part of COPA's Healthcare team that will meet 8-10 times over year
-
Healthcare team will hold 6 research actions to learn best practices of healthcare programs for undocumented residents
-
Hold 3-5 Healthcare Academies in churches and schools to look for leadership, outreach reaching 500-800 Monterey County residents.
-
Provide 6-8 leadership training sessions to teach civic engagement skills to develop new leadership
-
Hold large Public Action to hold public officials accountable and secure their public support for permanent program.
1) 60% FTE Community Organizer ($56,000 plus benefits = $74,500)
2) Program Coordinator 20 % ($11,000)
3) Travel & Mileage ($1,800)
4) Indirect Costs ($7,200)
5) Training ($4,000)
$25,000 of a $98,500 project
.
5.5 - Beginnings of the Space ProgramIn this discussion activi.docxGrazynaBroyles24
5.5 - Beginnings of the Space Program
In this discussion activity, address the following:
This time period saw the beginning of the American space program, from the first artificial satellites to the plans for landing men on the Moon. Discuss the advances in rocketry and other technology that made this possible.
After being upstaged by Soviets’ launching of Sputnik in 1957, the United States achieved dominance in space within a few years. To what do you attribute this success?
The primary posting should be approximately 100 words
.
5.3 - Discussion Ethical issuesReview the pros and cons of glob.docxGrazynaBroyles24
5.3 - Discussion: Ethical issues
Review the pros and cons of globalization in figure 10-1 on page 303. What is your opinion of globalization? Provide an Internet source to back up your opinion. 250 WORDS
USE;
Carroll, A. B., & Buchholtz, A. K. (2012).
Business and society: Ethics, sustainability, and
stakeholder management
. Florence, KY: Southwestern College Publishing.
.
500 words APA formatHow much impact do managers actually have on a.docxGrazynaBroyles24
500 words APA format
How much impact do managers actually have on an organization’s success or failure?
Provide one example of a manager who has affected the success or failure of an organization.
Knowledge and Understanding
Demonstrated depth of understanding of the topic.
Critical Thinking
Provides at least one relevant example related to topic.
.
5.2Complete one of the following options for your Week 5 Assignm.docxGrazynaBroyles24
5.2
Complete
one of the following options for your Week 5 Assignment:
Option A
Art in Your Community
Experience
the arts in your local community by attending a performance, or visiting an art museum or gallery. If you go to an art museum or gallery, choose an exhibition or one artwork to discuss for this assignment.
Write
a review of your arts experience that includes a defense of the arts. Include the following:
Write a description of the elements of composition: line, color, shape, or movement, theme, rhythm, tone, and so forth that were incorporated into the performance or artwork.
What was the overall emotional and intellectual effect the performance or artwork had on you? What emotions did you feel? Of what did the experience make you think?
Write a summary of how you would like to see the arts made more a part of your community. Is there anything you can do to make this happen? How will you support the arts in the future?
Include a defense of the arts that describes how the arts add value to life. How might creative expression be helpful to people?
Submit
your assignment as a Word document using the Assignment Files tab:
A 1200 word paper (You are welcome to go over the word count if you wish.)
.
5.1 DBDisparities exist among racial and ethnic groups with rega.docxGrazynaBroyles24
5.1 DB
Disparities exist among racial and ethnic groups with regard to their health. Non-Hispanic Caucasians were more likely to be in very good or excellent health than were other groups nationally and in almost every state. Education appears to be an indicator of improved health in non-Hispanic Caucasians than other groups. What is contributing to this disparity? What is the significance to healthcare administrators?
.
5. What are the most common types of computer-based information syst.docxGrazynaBroyles24
5. What are the most common types of computer-based information systems used in business organizations today? (Hint: a Transaction Processing System is one type.) Give a specific real-world example of each.
11. What are some general strategies employed by organiza- tions to achieve competitive advantage?
15. What is the role of the systems analyst? What is the role of the programmer?
16. What is the operations component of a typical IS department?
17. What is the role of the chief information officer
.
5.2 - Postwar Commercial AviationIn this discussion activity, .docxGrazynaBroyles24
5.2 - Postwar Commercial Aviation
In this discussion activity, address the following:
Scheduled air transport came of age in the decade after World War II. Using the textbook and doing some independent research, explain why airlines became an economical form of transport during this period.
Discuss aviation’s growing role in international trade and its increasing value to American society as a whole.
The primary posting should be approximately 100 words
. Review all submitted primary postings first, and ensure that your contribution is unique and adds to the discussion. In addition, you must also respond to
at least two
of your fellow students’ posts with substantive replies.
USE;
Roger E. Bilstein, Flight in America Third Edition if possible
.
5-6 paragraphsYou and Officer Landonio are on patrol. Yo.docxGrazynaBroyles24
5-6 paragraphs
You and Officer Landonio are on patrol. You see two juveniles sitting on the curb, and they are smoking what appears to be a marijuana cigarette. They are not trying to hide the fact that they are smoking marijuana, and you pull your patrol car over to talk to them. You run their names and find that one juvenile, Thomas Jones, does not have any record. But the other, Henry Thompson, has a long juvenile record. You now have the option to use, or not to use, your discretion.
Assignment Guidelines
In 5–6 paragraphs words, address the following:
In your own words, what is a chronic juvenile offender? Explain.
Do you take both boys into the juvenile assessment center? Do you let the juvenile without a record leave and take Henry Thompson to the juvenile assessment center? Or do you let both boys go with a warning?
Explain your decision.
What do you think would be the benefits of your decision? Explain.
What do you think would be the consequences to your decision? Explain
What are your state laws pertaining to marijuana? Explain.
Do you agree with these laws? Why or why not?
.
5-6 paragraphs Interagency is relatively recent as a term, y.docxGrazynaBroyles24
5-6 paragraphs
Interagency
is relatively recent as a term, yet as a concept, it has been in practice to varying degrees for as long as nations have had governments, fought wars, engaged in international commerce, or extended diplomacy. What is arguably a recent expansion of the interagency concept is the level of inclusiveness—that is, the broader scope of who is invited to participate in interagency activities. Also recent is the compulsion to use it, be it by leaders, for policies, or just from a plain "need" to employ an interagency approach to decision making and problem solving.
Assignment Guidelines
In 5–6 paragraphs, address the following:
What is your current understanding of the fundamentals of interagency relationships? Explain.
Consider horizontal relationships between federal agencies as well as vertical relationships between federal, state, and local agencies in your response.
What benefits do you think can be realized through effective interagency relationships? Explain.
What consequences might occur because of ineffective interagency relationships? Explain.
What 1 organization do you think should have the most responsibility regarding the formation and evaluation of interagency relations? Why?
.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
the bmj BMJ 2021;373n1343 doi 10.1136bmj.n1343 1R E
1. the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 1
R E S E A R C H
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
Steven H Woolf,1 Ryan K Masters,2 Laudan Y Aron3
ABSTRACT
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
2. 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 expectanc y 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 15 and 18 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 longsta nding 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.
3. Introduction
In 2020, covid-19 became the third leading cause of
death in the United States1 and was thus expected to
substantially lower life expectancy for that year (box
1). The US had more deaths from covid-19 than any
other country in the world and among the highest per
capita mortality rates.5 This surge in deaths prompted
speculation that the US would have a larger decrease
in life expectancy in 2020 than peer nations, but
empirical evidence has not been published. Americans
entered the pandemic at a distinct disadvantage relative
to other high income peer nations: improvements in
overall life expectancy have not kept pace with those
in peer countries since the 1980s,6 and in 2011, life
expectancy in the US plateaued and then decreased for
three consecutive years, further widening the gap in
mortality with peer nations.7
The effect of the pandemic on life expectancy
extends beyond deaths attributed to covid-19.8 Studies
have found an even larger number of excess deaths
during the pandemic, inflated by undocumented
deaths from covid-19 and by deaths from non-
covid-19 causes resulting from disruptions by the
pandemic (eg, reduced access to healthcare, economic
pressures, and mental health crises).9-12 Some racial
1Center on Society and Health,
Virginia Commonwealth
University School of Medicine,
Richmond, VA, USA
2Department of Sociology,
Health and Society Program and
Population Program, Institute of
Behavioral Science, University
of Colorado Population Center,
4. University of Colorado Boulder,
CO, USA
3Urban Institute, Washington,
DC, USA
Correspondence to: S H Woolf
[email protected]
(or @shwoolf on Twitter
ORCID 0000-0001-9384-033X)
Additional material is published
online only. To view please visit
the journal online.
Cite this as: BMJ 2021;373:n1343
http://dx.doi.org/10.1136/bmj.n1343
Accepted: 24 May 2021
WHAT IS ALREADY KNOWN ON THIS TOPIC
Because of systemic factors in the United States, the gap
between life
expectancy in the US and other high income countries has been
widening for
decades
In 2020, the US had more deaths from the covid-19 pandemic
than any other
country, but no study has quantified how the year’s large
number of deaths
affected life expectancy in the US or the gap with peer countries
WHAT THIS STUDY ADDS
Between 2018 and 2020, largely because of the covid-19
pandemic, life
expectancy in the US decreased by 1.87 years, 8.5 times the
average decrease in
peer countries, widening the gap in life expectancy with peer
countries to 4.69
years
5. In the US, decreases in life expectancy in Hispanic and non-
Hispanic Black
people were about two to three times greater than in the non-
Hispanic White
population, reversing years of progress in reducing racial and
ethnic disparities,
and lowering the life expectancy of Black men to 67.73 years, a
level not seen
since 1998
mailto:[email protected]
https://twitter.com/shwoolf?lang=en
https://orcid.org/0000-0001-9384-033X
https://crossmark.crossref.org/dialog/?doi=10.1136/bmj.n1343&
domain=pdf&date_stamp=2021-06-16
R E S E A R C H
2 doi: 10.1136/bmj.n1343 | BMJ 2021;373:n1343 | the bmj
and ethnic populations and age groups have been
disproportionately affected.13-15 Research on how the
pandemic has affected life expectancy is only just
emerging.16 17 Few studies have examined reductions
in 2020 life expectancy across racial and ethnic
groups, and none has compared the decline in the US
with other countries.
Methods
We estimated life expectancy at birth and at ages 25
and 65, examining the US population (in aggregate
and by sex, and by race and ethnicity) and the
populations of 16 high income countries (in aggregate
and by sex). Estimates of life expectancy for 2010-
6. 18 were calculated from official life tables and were
modeled for 2020. Estimates for 2019 would have
been preferable to determine the effect of the covid-19
pandemic but life table data were unavailable for many
peer countries. Life expectancy in the US is estimated
to have increased by only 0.1 years between 2018 and
2019,18 however, and therefore the changes seen in
life expectancy between 2018 and 2020 are largely
attributable to the events of 2020.
Data for peer countries did not include information
on race or ethnicity. US data were examined for
three racial and ethnic groups that constitute more
than 90% of the total population: Hispanic, non-
Hispanic Black, and non-Hispanic White populations.
Although many US individuals self-identify as Latino
or Latina, we used Hispanic to maintain consistency
with data sources. White and Black populations in
this study refer to people in these racial groups who
do not identify as Hispanic or Latinx.19 Estimates for
other important racial groups, such as Asian, Pacific
Islander, and Native American (American Indians and
Alaskan Natives) could not be calculated because the
National Center for Health Statistics does not provide
official life tables for these populations.
US life tables for 2010-18 were obtained from the
National Center for Health Statistics.20-28 Weekly
age specific death counts for all men and women in
the US and for Black, White, and Hispanic men and
women in the US for the years 2018 and 2020 were
obtained from the National Center for Health Statistics’
AH (ad hoc) Excess Deaths by Sex, Age, and Race
file.29 Mid-year population estimates by age, sex, and
race and ethnicity for men and women in the US for
2015-19 were obtained from the US Census Bureau.30
7. Population counts for 2020 were estimated from age
specific trends in US population estimates for 2015-19.
The National Center for Health Statistics and US Census
data were merged at ages 0-14, 15-19, . . . 80-84, ≥85
to calculate age specific death rates (mx) for 2018 and
2020 for men and women in the US in aggregate and by
race and ethnicity.
Peer countries included 16 high income democracies
with adequate data for analysis: Austria, Belgium,
Denmark, Finland, France, Israel, Netherlands, New
Zealand, Norway, South Korea, Portugal, Spain, Sweden,
Switzerland, Taiwan, and the United Kingdom. Taiwan
was treated as a country for our analysis although many
countries do not recognize it as an independent country.
Australia, Canada, Germany, Italy, and Japan were not
included because of incomplete mortality data. To
estimate life expectancy in these countries, five year
abridged life tables for male and female populations of
the peer countries were obtained for 2010-18 from the
Human Mortality Database31 (direct sources32 33 were
used for Israel and New Zealand because current data
were lacking in the Human Mortality Database). Weekly
death counts in 2018 and 2020 by country for ages
0-14, 15-64, 65-74, 75-84, and ≥85 were obtained from
the Human Mortality Database Short Term Mortality
Fluctuations files.
Box 1: Meaning of life expectancy during a pandemic
Life expectancy is a widely used statistic for summarizing a
population’s mortality
rates at a given time.2 It reflects how long a group of people
can expect to live were
they to experience at each age the prevailing age specific
mortality rates of that year.3
8. Estimates of life expectancy are sometimes misunderstood. We
cannot know the
future age specific mortality rates for people born or living
today, but we do know the
current rates. Computing life expectancy (at birth, or at ages 25
or 65) based on these
rates is valuable for understanding and comparing a country’s
mortality profile over
time or across places at a given point in time. Estimates of life
expectancy during the
covid-19 pandemic, such as those reported here, can help clar ify
which people or
places were most affected, but they do not predict how long a
group of people will
live. This study estimated life expectancy for 2020. Life
expectancy for 2021 and
subsequent years, and how quickly life expectancy will rebound,
cannot be calculated
until data for these years become available. Although life
expectancy is expected
to recover in time to levels before the pandemic, past pandemics
have shown that
survivors can be left with lifelong consequences, depending on
their age and other
socioeconomic circumstances.4
Visual Abstract Life expectancy in the wake of covid-19
The US has been hit harder than its peers
Study design
2010-20
mortality data
Data
analysis
11. -1.87
US
PC
HI BL
BL
US
PC
HI
R E S E A R C H
the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 3
To calculate life expectancy estimates for 2020, we
used data from the National Center for Health Statistics
and US Census Bureau to estimate rate ratios between
the age specific mortality rates of 2018 (2018 mx) and
2020 (2020 mx) for US populations. For populations in
peer countries, values for 2018 mx and 2020 mx, taken
from data in the Human Mortality Database Short
Term Mortality Fluctuations files, were estimated for
ages 0-14, 15-64, 65-74, 75-84, and ≥85. Age specific
mortality rate ratios between 2020 mx and 2018 mx data
in the Human Mortality Database Short Term Mortality
Fluctuations were estimated for each peer country in
aggregate and by sex. Age specific probabilities of death
in 2020 (qx), for ages 0-1, 1-4, 5-9, . . . 90-94, 95-99,
≥100, were estimated separately for men and women
in the US and for men and women in specific race and
12. ethnic group populations by multiplying 2018 mx
28
by the 2020-18 rate ratio estimates derived from data
from the National Center for Health Statistics and US
Census Bureau, and calculating qx=(mx×n)/(1+mx×ax),
where qx is the age specific probability of death, mx is
the age specific mortality rate, n is the width of the age
interval, and ax is the age specific person years lived
by the deceased.34 Probabilities of death for each peer
country in 2020 were estimated by multiplying qx in
the Human Mortality Database life tables by the 2020-
18 rate ratios in the Human Mortality Database Short
Term Mortality Fluctuations data.
We used Python (version 3.9.1) to simulate 50 000
five year abridged 2020 life tables for each US
subpopulation, with the estimated qx for 2020, ax
derived from 2018 official life tables,28 and random
10% error in the qx estimate. For each peer country
population, 50 000 five year abridged 2020 life tables
were simulated with the estimated 2020 qx and 2018
ax values in the Human Mortality Database 2018 life
tables, and random 10% error in the qx estimate. We
present median estimates of 2020 life expectancy at
birth and at ages 25 and 65; fifth and 95th centiles are
presented in the tables. The supplementary material
provides further details on methods.
Patient and public involvement
Involving patients or the public in the design, conduct,
reporting, or dissemination plans of our research was
not possible because of the urgency of the analysis and
its focus on decedents.
Results
13. United States
After a small increase of 0.08 years between 2010 and
2018, life expectancy in the US at birth decreased by
an estimated 1.87 years (or 2.4%) between 2018 and
2020 (fig 1 and supplementary fig 1). The proportional
decrease in life expectancy at ages 25 and 65 was even
greater (3.4% and 5.7%, respectively) (table 1). US
men had a larger decrease in overall life expectancy
than women, in both absolute (2.16 years v 1.50 years)
and relative (2.8% v 1.8%) terms.
Between 2018 and 2020, life expectancy in the
US decreased disproportionately among Black
and Hispanic populations (table 2). In the Black
population, life expectancy decreased by 3.25 years
(4.4%), 2.4 times the decrease in the White population
(1.36 years, 1.7%), with larger reductions in men
(3.56 years, 5.0%) than women (2.65 years, 3.4%).
In 2020, life expectancy in Black men was only 67.73
years. The decrease in life expectancy among Hispanic
individuals was even larger (3.88 years, 4.7%),
2.9 times the decrease in White people, with larger
reductions in men (4.58 years, 5.8%) than women
(2.94 years, 3.5%).
The disproportionate decrease in life expectancy
in the US Black population during 2018-20 reversed
years of progress in reducing the gap in mortality
between Black and White populations. Although
the gap in life expectancy between Black and White
populations decreased from 4.02 years in 2010 to 3.54
years in 2014, the gap increased to 3.92 years in 2018,
and to 5.81 years in 2020. Historically, the US Hispanic
population has had a longer life expectancy than
the White population.35 36 Although that advantage
14. widened between 2010 and 2017, from 2.91 years to
3.30 years, the gap decreased to 3.20 years in 2018
and then decreased sharply to 0.68 years in 2020
(table 2); the advantage reversed entirely in Hispanic
men (from 2.88 years in 2018 to −0.20 years in 2020).
United States versus peer countries
Figure 1 presents estimates of life expectancy for
2010-18 and 2020 for the US and the average for
16 high income countries. The US began the decade
with a 1.88 year deficit in life expectancy relative to
peer countries. This gap increased over the decade,
reaching 3.05 years in 2018. Between 2018 and 2020,
the gap widened substantially to 4.69 years: the 1.87
year decrease in life expectancy in the US was 8.5 times
the average decrease in peer countries (0.22 years).
Table 3 presents the estimates of life expectancy for
peer countries at birth, and at ages 25 and 65 in 2010,
2018, and 2020.
Changes in life expectancy varied substantially
across peer countries. Six countries (Denmark, Finland,
New Zealand, Norway, South Korea, and Taiwan) had
increases in life expectancy between 2018 and 2020.
Among the other 10 peer countries, decreases in life
expectancy ranged from 0.12 years in Sweden to 1.09
years in Spain, but none approached the 1.87 year loss
seen in the US.
Figure 2 (and supplementary fig 2) contrasts changes
in life expectancy in the US in 2010-18 and 2018-20
with those of peer countries, based on sex, and on
race and ethnicity. Figure 3 (and supplementary fig
3) shows how these changes contributed to the gap
between the US and peer countries. For example, figure
2 shows that life expectancy for US women increased
15. by 0.21 years in 2010-18, but because life expectancy
in women in the peer countries increased even more
(0.98 years), the gap increased by 0.77 years (fig 3).
The gap increased by another 1.36 years during 2018-
20, largely because of the pandemic. Overall, the
gap between the US and peer countries for women
R E S E A R C H
4 doi: 10.1136/bmj.n1343 | BMJ 2021;373:n1343 | the bmj
increased by 2.14 years (fig 3), from 1.97 years in 2010
(81.04 v 83.01 years) to 4.11 years (79.75 v 83.86
years) in 2020 (table 1 and table 3). The gap between
the US and peer countries for men increased even more
(3.37 years) (fig 3). In 2020, life expectancy for US men
was 5.27 years (74.06 v 79.33 years) shorter than the
peer country average for men.
The demographic composition and ethnic inequities
of peer countries varied considerably, making it
difficult to identify analogous reference populations
to compare with the US racial and ethnic groups. But
the peer country average provides a useful benchmark
for showing the disproportionately large decreases
in life expectancy in Black and Hispanic populations
in the US (fig 1, fig 2, and fig 3). For example, among
Black men and women in the US, the decrease in life
expectancy between 2018 and 2020 was 12.3 times
and 20.3 times greater, respectively, than the average
decrease for men and women in peer countries. The
corresponding values were even larger for the Hispanic
population in the US, with estimated declines in life
16. expectancy 15.9 times and 22.5 times higher among
men and women, respectively, compared with their
counterparts in peer countries.
Discussion
Long before covid-19, the US was at a disadvantage
relative to other high income nations in terms of health
and survival.6 37-41 In 2013, a report by the National
Research Council and Institute of Medicine showed that
from the 1980s, the US had higher rates of morbidity
and mortality for multiple conditions relative to other
high income countries.6 A recent report by the National
Academies of Sciences, Engineering, and Medicine
found that this gap widened further through 2017
and that the greatest relative increase in mortality
in the US occurred in young and middle aged adults
(aged 25-64). Increased mortality in this age group
was largely because of deaths from drug use, suicide,
cardiometabolic diseases, and other chronic illnesses
and injuries.42 Between 2014 and 2017, whereas life
expectancy continued to increase in other countries,
life expectancy in the US decreased by 0.3 years,7 a
three year decline that generated considerable public
concern43 but is now overshadowed by the large 2020
declines reported here. Even countries with much lower
per capita incomes outperform the US.44-47 According
to data for 36 member countries of the Organization for
Economic Cooperation and Development (OECD), the
gap in life expectancy between the US and the OECD
average increased from 0.9 to 2.2 years between 2010
and 2017.48 49
This study shows that the gap in life expectancy in
the US increased markedly between 2018 and 2020.
The decrease in life expectancy in the US was 8.5 times
the average loss seen in 16 high income peer nations
17. and the largest decrease since 1943 during the second
world war.50 The conditions that produced a US health
disadvantage before the arrival of covid-19 are still
in place, but the predominant cause for this large
decline was the covid-19 pandemic: in 2020, all cause
mortality in the US increased by 23%.12
We found large differences in the reductions in life
expectancy during the covid-19 pandemic based on
race and ethnicity. Decreases in life expectancy among
Black and Hispanic men and women were about two
to three times greater than in White people, and far
larger than those in peer countries. Decreases in life
expectancy of US Black and Hispanic men were 12-
16 times greater than those in men from other high
income countries. Corresponding decreases in life
Year
Year
L
if
e
e
xp
e
ct
an
cy
a
19. cy
(y
e
ar
s)
0
2
3
5
4
1
2010 2011 2012 2013 2014 2015 2016 2017 2018 2020
1.88
2.11 2.08
2.36 2.57
2.69
2.95 3.11 3.05
4.69
Peer countries ±1 standard deviation
Observed
20. *Gap in life expectany between US and peer countries (years)
US total
US Hispanic
US non-Hispanic White
US non-Hispanic Black
Estimated
Decrease
between
2018 and
2020
1.88 year gap*
-3.88
-1.36
-3.25
Fig 1 | Life expectancy at birth in the United States, by race and
ethnicity, and in
peer countries, for years 2010-18 and 2020. Data obtained from
the National Center
for Health Statistics, US Census Bureau, and Human Mortality
Database. Data for
2019 could not be calculated because life table data were
unavailable for many peer
countries
Table 1 | Life expectancy in the United States at birth, and at
ages 25 and 65, by sex, for
years 2010, 2018, and 2020
21. Life expectancy (years) Change in life expectancy (years, P5,
P95)
2010 2018 2020 (years, P5, P95) 2018 v 2010 2020 v 2018
Life expectancy at birth
Total 78.66 78.74 76.87 (76.70 to 77.04) 0.08 −1.87 (−2.04 to
−1.70)
Women 81.04 81.25 79.75 (79.59 to 79.92) 0.21 −1.50 (−1.66 to
−1.33)
Men 76.20 76.22 74.06 (73.88 to 74.24) 0.02 −2.16 (−2.34 to
−1.98)
Life expectancy at age 25
Total 54.71 54.76 52.91 (52.74 to 53.09) 0.05 −1.84 (−2.02 to
−1.67)
Women 56.87 57.04 55.54 (55.37 to 55.71) 0.17 −1.51 (−1.67 to
−1.34)
Men 52.44 52.43 50.32 (50.14 to 50.50) −0.01 −2.12 (−2.29 to
−1.93)
Life expectancy at age 65
Total 19.13 19.47 18.37 (18.19 to 18.55) 0.34 −1.11 (−1.28 to
−0.93)
Women 20.33 20.69 19.67 (19.50 to 19.84) 0.36 −1.02 (−1.19 to
−0.85)
Men 17.70 18.10 16.93 (16.75 to 17.12) 0.40 −1.16 (−1.34 to
−0.98)
P5, P95=5th and 95th centiles of 50 000 simulated life
expectancies with 10% random uncertainty around the
estimated probability of death for 2020.
Data derived from the National Center for Health Statistics, US
Census Bureau, and Human Mortality Database.
Sums might differ from text because of rounding.
R E S E A R C H
22. the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 5
expectancy among US Black and Hispanic women
were 20-23 times greater than those for women in peer
countries. Progress made between 2010 and 2018 in
reducing the gap in life expectancy between Black and
White populations in the US was erased between 2018
and 2020. Life expectancy in Black men fell to 67.73
years, a level not seen since 1998.51 The US Hispanic
life expectancy advantage was erased in men and
nearly disappeared in women.
Strengths and limitations of this study
Our study estimated the effect of the covid-19
pandemic on life expectancy in the US for 2020, and
compared life expectancy in the US with other high
income countries. The study used a new method for
these calculations, detailed in the supplementary
appendix. The study also had several limitations.
First, life expectancies for 2020 were simulated with
preliminary mortality data, which are subject to errors
(eg, undercounting, and mismatching between death
and population counts) and often vary across racial and
ethnic populations and countries. Second, the 2020 qx
values used to generate life tables for peer populations
could have been biased by the wide age ranges used
in the Human Mortality Database Short Term Mortality
Fluctuations files. Third, definitions for peer countries
vary; our list differs from the 16 high income countries
used in several cross national comparisons.6 37 38 Five
large high income democracies (Australia, Canada,
Germany, Italy, and Japan) were excluded because of
incomplete data. Fourth, we compared life expectancy
in 2020 with 2018 values; the effect of the pandemic
23. would be better determined by comparisons with life
expectancy in 2019, but data for many peer countries
were unavailable for this calculation Fifth, for reasons
explained in the supplementary material, data on
race and ethnicity for the US population and for 2020
deaths were incomplete,52 likely underestimating
racial inequalities. Reports suggest that covid-19 and
all cause mortality in 2020 were very high in American
Table 2 | Life expectancy in the United States at birth, and at
ages 25 and 65, by sex, race, and ethnicity, for years 2010,
2018, and 2020
Life expectancy (years) Change in life expectancy (years, P5,
P95)
2010 2018 2020 (P5, P95) 2018 v 2010 2020 v 2018
Life expectancy at birth
Total
Hispanic 81.68 81.83 77.95 (77.78 to 78.12) 0.15 −3.88 (−4.05
to −3.71)
Non-Hispanic Black 74.75 74.71 71.46 (71.27 to 71.65) −0.04
−3.25 (−3.44 to −3.06)
Non-Hispanic White 78.76 78.63 77.27 (77.10 to 77.44) −0.13
−1.36 (−1.53 to −1.19)
Women
Hispanic 84.26 84.32 81.38 (81.22 to 81.54) 0.06 −2.94 (−3.10
to −2.78)
Non-Hispanic Black 77.70 77.99 75.34 (75.16 to 75.52) 0.29
−2.65 (−2.83 to −2.47)
Non-Hispanic White 81.12 81.10 79.99 (79.83 to 80.16) −0.02
−1.11 (−1.27 to −0.94)
Men
Hispanic 78.84 79.08 74.50 (74.33 to 74.68) 0.24 −4.58 (−4.75
to −4.40)
Non-Hispanic Black 71.51 71.29 67.73 (67.54 to 67.93) −0.22
24. −3.56 (−3.75 to −3.36)
Non-Hispanic White 76.35 76.20 74.70 (74.52 to 74.87) −0.15
−1.50 (−1.68 to −1.33)
Life expectancy at age 25
Total
Hispanic 57.57 57.71 53.85 (53.68 to 54.03) 0.14 −3.86 (−4.03
to −3.68)
Non-Hispanic Black 51.42 51.43 48.34 (48.15 to 48.53) 0.01
−3.09 (−3.28 to −2.90)
Non-Hispanic White 54.72 54.54 53.16 (52,99 to 53.33) −0.18
−1.38 (−1.55 to −1.21)
Women
Hispanic 59.97 60.06 57.12 (56.96 to 57.29) 0.09 −2.94 (−3.10
to −2.77)
Non-Hispanic Black 54.00 54.28 51.69 (51.51 to 51.87) 0.28
−2.59 (−2.77 to −2.41)
Non-Hispanic White 56.86 56.80 55.66 (55.49 to 55.82) −0.06
−1.14 (−1.31 to −0.98)
Men
Hispanic 54.88 55.11 50.62 (50.44 to 50.80) 0.23 −4.49 (−4.67
to −4.31)
Non-Hispanic Black 48.47 48.33 44.99 (44.79 to 45.19) −0.14
−3.34 (−3.54 to −3.14)
Non-Hispanic White 52.50 52.29 50.77 (50.59 to 50.95) −0.21
−1.52 (−1.70 to −1.34)
Life expectancy at age 65
Total
Hispanic 21.15 21.44 18.85 (18.67 to 19.03) 0.29 −2.59 (−2.77
to −2.41)
Non-Hispanic Black 17.71 18.02 16.13 (15.93 to 16.32) 0.31
−1.89 (−2.09 to −1.70)
Non-Hispanic White 19.11 19.38 18.50 (18.33 to 18.68) 0.27
−0.88 (−1.05 to −0.70)
Women
Hispanic 22.62 22.70 20.54 (20.38 to 20.72) 0.08 −2.16 (−2.32
to −1.98)
25. Non-Hispanic Black 19.15 19.52 17.76 (17.57 to 17.94) 0.37
−1.76 (−1.95 to −1.58)
Non-Hispanic White 20.28 20.58 19.77 (19.60 to 19.94) 0.30
−0.81 (−0.98 to −0.64)
Men
Hispanic 19.23 19.73 16.86 (16.68 to 17.05) 0.50 −2.87 (−3.05
to −2.68)
Non-Hispanic Black 15.79 16.11 14.24 (14.04 to 14.44) 0.32
−1.87 (−2.07 to −1.67)
Non-Hispanic White 17.72 18.06 17.16 (16.98 to 17.34) 0.34
−0.90 (−1.08 to −0.72)
P5, P95=5
th and 95th centiles of 50 000 simulated life expectancies with
10% random uncertainty around the estimated probability of
death for 2020.
Data derived from the National Center for Health Statistics, US
Census Bureau, and Human Mortality Database. Sums might
differ from text because of
rounding.
R E S E A R C H
6 doi: 10.1136/bmj.n1343 | BMJ 2021;373:n1343 | the bmj
Indian and Alaskan Native populations.53 Finally,
we used the average for peer countries; values for
individual countries varied.
Comparisons with other studies
This study aligns closely with previous research. An
analysis of deaths between January and June 2020
found that US life expectancy decreased by 1.0 years
between 2019 and 2020, including reductions of 0.8
26. years in White people and reductions of 2.7 years
and 1.9 years in Black and Hispanic individuals,
respectively.17 Andrasfay and Goldman estimated that
life expectancy from January to mid-October 2020 was
1.1 years below expected values, including a reduction
of 0.7 years in White populations and reductions of
2.1 and 3.1 years in Black and Hispanic populations,
respectively.16 Neither study examined changes in
life expectancy in other countries or estimated life
expectancy in the US for the whole of 2020.
Policy implications
The decreases in life expectancy that we found and
the excess deaths reported in several studies of 2020
death counts9-12 could reflect the combined effects of
deaths attributed to covid-19, deaths where SARS Co-
V-2 infection was unrecognized or undocumented,
and deaths from non-covid-19 health conditions,
exacerbated by limited access to healthcare and
by widespread social and economic disruptions
produced by the pandemic (eg, unemployment, food
insecurity, and homelessness).8 54 These adverse
outcomes are products of national, state, and local
policy decisions, and actions and inactions that
influenced viral transmission and management of
the pandemic.55-60 These policies span healthcare,
public health, employment, education, and social
protection systems. Many organizations are tracking
these decisions internationally for ongoing research
and development.61-64
The large number of covid-19 deaths in the US
reflects not only the country’s policy choices and
mishandling of the pandemic55-60 but also deeply
rooted factors that have put the country at a health
27. disadvantage for decades.6 7 65 66 For much of the
public, it was the pandemic itself that drew attention
to these longstanding conditions, including major
deficiencies in the US healthcare and public health
systems, widening social and economic inequality,
and stark inequities and injustices experienced by
Black, Hispanic, Asian, and Indigenous populations
and other systematically marginalized and excluded
groups. Many studies have reported that rates of
covid-19 infections, admissions to hospital, and
deaths are substantially higher in Black and Hispanic
populations compared with White people, because of
greater exposure to the virus, a higher prevalence of
comorbid conditions (eg, diabetes), and reduced access
to healthcare and other protective resources.67 68
Evidence of disproportionate reductions in life
expectancy among racial and ethnic groups in the US,
such as the disparities reported here, draws attention
to the root causes of racial inequities in health, wealth,
and wellbeing. Foremost among these root causes is
systemic racism; extensive research has shown that
systems of power in the US structure opportunity
and assign value in ways that unfairly disadvantage
Black, Hispanic, Asian, and Indigenous populations,
and unfairly advantage White people.69-75 Many of
the same factors placed these populations at greater
risk from covid-19.13-15 76-80 The higher prevalence of
comorbid conditions in many racial or marginalized
Table 3 | Average life expectancy in peer countries at birth, and
at ages 25 and 65, by
sex, for years 2010, 2018, and 2020
Life expectancy (years) Change in life expectancy (years, P5,
P95)
28. 2010 2018 2020 (P5, P95) 2018 v 2010 2020 v 2018
Life expectancy at birth
Total 80.54 81.78 81.56 (81.40 to 81.71) 1.24 −0.22 (−0.38 to
−0.07)
Women 83.01 83.99 83.86 (83.71 to 84.01) 0.98 −0.13 (−0.28 to
0.02)
Men 78.10 79.62 79.33 (79.17 to 79.49) 1.52 −0.29 (−0.45 to
−0.13)
Life expectancy at age 25
Total 56.21 57.35 57.08 (56.93 to 57.24) 1.14 −0.27 (−0.42 to
−0.11)
Women 58.56 59.47 59.29 (59.14 to 59.44) 0.91 −0.18 (−0.33 to
−0.03)
Men 53.86 55.26 54.94 (54.78 to 55.10) 1.40 −0.32 (−0.48 to
−0.16)
Life expectancy at age 65
Total 19.53 20.31 20.05 (19.89 to 20.21) 0.78 −0.26 (−0.42 to
−0.10)
Women 21.00 21.69 21.50 (21.35 to 21.66) 0.69 −0.19 (−0.34 to
0.03)
Men 17.88 18.82 18.53 (18.36 to 18.69) 0.94 −0.29 (−0.46 to
−0.13)
P5, P95=5th and 95th percentiles of 50 000 simulated life
expectancies with 10% random uncertainty around the
estimated probability of death for 2020.
Data derived from the National Center for Health Statistics, US
Census Bureau, and Human Mortality Database.
Sums might differ from text because of rounding.
2010-18 2018-20Women
Change in life expectancy
C
h
32. US non-
Hispanic
Black
US non-
Hispanic
White
1.52
0.02 0.24
-0.22
-0.15-0.29
-2.16
-4.58
-3.56
-1.50
Fig 2 | Changes in life expectancy at birth in US populations
and peer country average,
for years 2010-18 and 2018-20. For example, life expectancy in
the US for women
increased by 0.21 years in 2010-18 and then decreased by 1.50
years in 2018-20. Data
derived from the National Center for Health Statistics, US
Census Bureau, and Human
Mortality Database
33. R E S E A R C H
the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 7
groups is a reflection of unequal access to the social
determinants of health (eg, education, income, and
justice) and not their race, ethnicity, or other socially
determined constructs. Low income communities and
women have also been disproportionately affected by
the social, familial, and economic disruptions of the
pandemic.81 82 Reduced access to covid-19 vaccines,
and vaccine hesitancy rooted in a community’s
distrust of systems that have mistreated them, might
exacerbate these disparities. Structural factors affect
not only Black and Hispanic populations but other
marginalized people and places. American Indians
and Alaskan Natives, for example, have some of the
worst health outcomes of any group in the US, but data
limitations precluded separate calculations for these
important populations.
Conclusions
The mortality outcomes examined in this study, in the
research literature, and in the daily news represent
only part of the burden of covid-19; for every death,
a larger number of infected individuals experience
acute illness, and many face long term health and life
complications.83 Whether some of these long term
complications will affect how quickly life expectancy
in the US will rebound in the coming years is unclear.
Morbidity and mortality during the pandemic have
wider effects on families, neighborhoods, and
communities. One study estimated that each death
leaves behind an average of nine bereaved family
34. members.84 The pandemic will have short and long
term effects on the social determinants of health,
changing living conditions in many communities,
and altering life course trajectories across age groups.
Fully understanding the health consequences of these
changes poses a daunting but important challenge for
future research.
We thank Steven Martin, Urban Institute, for reviewing our
methodology; Cassandra Ellison, art director for the Virginia
Commonwealth University Center on Society and Health, for
her
assistance with graphic design; and Catherine Talbot,
University of
Colorado Boulder, for her advice with Python simulations.
These
individuals received no compensation beyond their salaries.
Contributors: SHW led the production of this manuscript and
had primary responsibility for the composition. He is guarantor.
RKM contributed revisions and had primary responsibility for
data
acquisition and analysis, the modeling results that form the
basis
for this study, and production of the supplementary material.
LYA
contributed revisions and had primary responsibility for dealing
with the study’s policy implications in the discussion section.
The
corresponding author attests that all listed authors meet
authorship
criteria and that no others meeting the criteria have been
omitted.
Funding: SHW received partial funding from grant
UL1TR002649
from the National Center for Advancing Translational Sciences.
RKM
received support from the University of Colorado Population
35. Center
grant from the Eunice Kennedy Shriver Institute of Child Health
and
Human Development (CUPC project 2P2CHD066613-06). There
was
no specific funding for this study.
Competing interests: All authors have completed the ICMJE
uniform
disclosure form at www.icmje.org/coi_disclosure.pdf and
declare: no
support from any organization for the submitted work; no
financial
relationships with any organizations that might have an interest
in the
submitted work in the previous three years; and no other
relationships
or activities that could appear to have influenced the submitted
work.
The lead author (SHW) affirms that the manuscript is an honest,
accurate, and transparent account of the study being reported;
that
no important aspects of the study have been omitted; and that
any
discrepancies from the study as planned have been explained.
Dissemination to participants and related patient and public
communities: Print, broadcast, and social medial will be used to
disseminate the results of this study to journalists and the
public,
and summaries will be shared with policy makers, social justice
organizations, and other relevant stakeholders.
Provenance and peer review: Not commissioned; externally peer
reviewed.
Ethical approval: Not required.
Data sharing: Requests for additional data and analytic scripts
used
in this study should be emailed to RKM ([email protected]).
36. This is an Open Access article distributed in accordance with
the
Creative Commons Attribution Non Commercial (CC BY-NC
4.0) license,
which permits others to distribute, remix, adapt, build upon this
work
non-commercially, and license their derivative works on
different
terms, provided the original work is properly cited and the use
is non-
commercial. See: http://creativecommons.org/licenses/by-
nc/4.0/.
1 Woolf SH, Chapman DA, Lee JH. COVID-19 as the leading
cause of
death in the United States. JAMA 2021;325:123-4.
2 Riley JC. Rising Life Expectancy: A Global History .
Cambridge
University Press, 2001. doi:10.1017/CBO9781316036495.
3 Preston S, Heuveline P, Guillot M. Demography: Measuring
and
Modeling Population Processes. Blackwell Publishers, 2001.
4 Almond D. Is the 1918 influenza pandemic over? Long-term
effects
of in utero influenza exposure in the post-1940 US population. J
Polit
Econ 2006;114:672-712. doi:10.1086/507154.
5 Dong E, Du H, Gardner L. An interactive web-based
dashboard
to track COVID-19 in real time. Lancet Infect Dis 2020;20:533-
4.
doi:10.1016/S1473-3099(20)30120-1.
37. 6 Woolf SH, Aron L, eds. U.S. Health in International
Perspective: Shorter
Lives, Poorer Health. Panel on Understanding Cross-National
Health
Differences Among High-Income Countries. National Research
Council,
Committee on Population, Division of Behavioral and Social
Sciences
and Education, and Board on Population Health and Public
Health
Practice, Institute of Medicine. National Academies Press,
2013.
2010-18 2018-20Women
In
cr
e
as
e
in
g
ap
in
li
fe
e
xp
e
43. 1.00
3.27
5.01
1.74
1.22
2.89
1.671.28
4.29
Fig 3 | Increasing gap in life expectancy between the United
States and peer country
average, for years 2010-18 and 2018-20. For example, the gap
between life expectancy
for men in the US men and the average life expectancy for men
in peer countries
increased by 1.50 years in 2010-18 and by a further 1.87 years
in 2018-20. Data
derived from the National Center for Health Statistics, US
Census Bureau, and Human
Mortality Database. Sums might differ because of rounding
http://www.icmje.org/coi_disclosure.pdf
http://creativecommons.org/licenses/by-nc/4.0/
R E S E A R C H
8 doi: 10.1136/bmj.n1343 | BMJ 2021;373:n1343 | the bmj
44. 7 Woolf SH, Schoomaker H. Life expectancy and mortality
rates in
the United States, 1959-2017. JAMA 2019;322:1996-2016.
doi:10.1001/jama.2019.16932
8 Matthay EC, Duchowny KA, Riley AR, Galea S. Projected
all-cause
deaths attributable to COVID-19-related unemployment in the
United States. Am J Public Health 2021;111:696-9. doi:10.2105/
AJPH.2020.306095
9 Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L.
Excess
deaths from COVID-19 and other causes, March-April 2020.
JAMA 2020;324:510-3. doi:10.1001/jama.2020.11787
10 Weinberger DM, Chen J, Cohen T, et al. Estimation of
excess deaths
associated with the COVID-19 pandemic in the United States,
March
to May 2020. JAMA Intern Med 2020;180:1336-44.
doi:10.1001/
jamainternmed.2020.3391
11 Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L,
Taylor DDH.
Excess deaths from COVID-19 and other causes, March-July
2020.
JAMA 2020;324:1562-4. doi:10.1001/jama.2020.19545
12 Woolf SH, Chapman DA, Sabo RT, Zimmerman EB. Excess
deaths from
COVID-19 and other causes in the US, March 1, 2020, to
January 2,
2021. JAMA 2021. doi:10.1001/jama.2021.5199
45. 13 Rossen LM, Branum AM, Ahmad FB, Sutton P, Anderson
RN. Excess
deaths associated with COVID-19, by age and race and
ethnicity.
United States, January 26-October 3, 2020. MMWR Morb
Mortal Wkly
Rep 2020;69:1522-27.
14 Jacobson SH, Jokela JA. Non-COVID-19 excess deaths by
age and
gender in the United States during the first three months of the
COVID-19 pandemic. Public Health 2020;189:101-3.
doi:10.1016/j.
puhe.2020.10.004
15 Centers for Disease Control and Prevention. Risk for
COVID-19
Infection, Hospitalization, and Death By Race/Ethnicity. 2021.
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/
investigations-discovery/hospitalization-death-by-race-
ethnicity.html
16 Andrasfay T, Goldman N. Reductions in 2020 US life
expectancy due to COVID-19 and the disproportionate impact
on the Black and Latino populations. Proc Natl Acad Sci U S
A 2021;118:e2014746118. doi:10.1073/pnas.2014746118
17 Arias E, Tejada-Vera B, Ahmad F. Provisional life
expectancy estimates
for January through June, 2020. Vital Statistics Rapid Release;
no
10. Hyattsville, MD: National Center for Health Statistics.
2021.
doi:10.15620/cdc:100392.
46. 18 Kochanek KD, Xu JQ, Arias E. Mortality in the United
States, 2019.
NCHS Data Brief, no 395. National Center for Health Statistics,
2020.
19 Flanagin A, Frey T, Christiansen SL, Bauchner H. The
Reporting of Race
and Ethnicity in Medical and Science Journals: Comments
Invited.
JAMA 2021;325:1049-52. doi:10.1001/jama.2021.2104
20 Arias E. United States life tables, 2010. Natl Vital Stat
Rep 2014;63:1-63.
21 Arias E. United States life tables, 2011. Natl Vital Stat
Rep 2015;64:1-63.
22 Arias E, Heron M, Xu J. United States life tables, 2012.
Natl Vital Stat
Rep 2016;65:1-65.
23 Arias E, Heron M, Xu J. United States life tables, 2013.
Natl Vital Stat
Rep 2017;66:1-64.
24 Arias E, Heron M, Xu J. United States life tables, 2014.
Natl Vital Stat
Rep 2017;66:1-64.
25 Arias E, Xu J. United States life tables, 2015. Natl Vital
Stat
Rep 2018;67:1-64.
26 Arias E, Xu J, Kochanek KD. United States life tables,
2016. Natl Vital
Stat Rep 2019;68:1-66.
47. 27 Arias E. United States Life Tables, 2017. Natl Vital Stat
Rep 2019;68:1-66.
28 Arias E, Xu J. United States life tables, 2018. Natl Vital
Stat
Rep 2020;69:1-45.
29 HealthData.gov. AH Excess Deaths by Sex, Age, and Race.
2021.
https://data.cdc.gov/NCHS/AH-Excess-Deaths-by-Sex-Age-and-
Race/
m74n-4hbs
30 US Census Bureau. 2019 Population Estimates by Age, Sex,
Race and
Hispanic Origin. 2020.
https://www.census.gov/newsroom/press-
kits/2020/population-estimates-detailed.html
31 University of California, Berkeley and Max Planck Institute
for
Demographic Research. Human Mortality Database.
https://www.
mortality.org/
32 State of Israel. Complete Life Tables of Israel, 2014-2018.
2020.
https://www.cbs.gov.il/en/publications/Pages/2020/Complete-
Life-
Tables-Of%20Israel-2014-2018.aspx
33 New Zealand Government. National and subnational period
life
tables: 2017-2019. 2021. https://www.stats.govt.nz/information-
releases/national-and-subnational-period-life-tables-2017-2019.
48. 34 Preston S, Heuveline P, Guillot M. Demography: Measuring
and
Modeling Population Processes. Blackwell Publishers, 2001.
35 Ruiz JM, Steffen P, Smith TB. Hispanic mortality paradox:
a systematic
review and meta-analysis of the longitudinal literature. Am J
Public
Health 2013;103:e52-60. doi:10.2105/AJPH.2012.301103
36 Chen Y, Freedman ND, Rodriquez EJ, et al. Trends in
premature
deaths among adults in the United States and Latin America.
JAMA Netw Open 2020;3:e1921085. doi:10.1001/
jamanetworkopen.2019.21085
37 Crimmins EM, Preston SH, Cohen B. Explaining Divergent
Levels of
Longevity in High-Income Countries . National Academies
Press,
2011.
38 Ho JY. Mortality under age 50 accounts for much of the fact
that US
life expectancy lags that of other high-income countries. Health
Aff
(Millwood) 2013;32:459-67. doi:10.1377/hlthaff.2012.0574
39 Ho JY, Hendi AS. Recent trends in life expectancy across
high income
countries: retrospective observational study.
BMJ 2018;362:k2562.
doi:10.1136/bmj.k2562
49. 40 Emanuel EJ, Gudbranson E, Van Parys J, Gørtz M,
Helgeland J, Skinner
J. Comparing Health Outcomes of Privileged US Citizens With
Those
of Average Residents of Other Developed Countries. JAMA
Intern
Med 2021;181:339-44. doi:10.1001/jamainternmed.2020.7484.
41 Preston SH, Vierboom YC. Excess mortality in the United
States in the
21st century. Proc Natl Acad Sci U S A 2021;118:e2024850118.
doi:10.1073/pnas.2024850118
42 National Academies of Sciences, Engineering, and
Medicine. High
and Rising Mortality Rates Among Working-Age
Adults. National
Academies Press, 2021. doi:10.17226/25976.
43 Bernstein L. Life expectancy declines again, a dismal trend
not seen since World War I. Washington Post 2018. https://
www.washingtonpost.com/national/healthscience/us-life-
expectancy-declines-again-adismal-trend-not-seen-since-
world-war-i/2018/11/28/ae58bc8c-f28c-11e8-bc79-
68604ed88993story.html.
44 Avendano M, Kawachi I. Why do Americans have shorter
life
expectancy and worse health than do people in other high-
income
countries?Annu Rev Public Health 2014;35:307-25.
doi:10.1146/
annurev-publhealth-032013-182411
45 GBD 2017 Mortality Collaborators. Global, regional, and
national
50. age-sex-specific mortality and life expectancy, 1950-2017:
a systematic analysis for the Global Burden of Disease Study
2017. Lancet 2018;392:1684-735. doi:10.1016/S0140-
6736(18)31891-9
46 GBD 2017 DALYs and HALE Collaborators. Global,
regional, and
national disability-adjusted life-years (DALYs) for 359 diseases
and
injuries and healthy life expectancy (HALE) for 195 countries
and
territories, 1990-2017: a systematic analysis for the Global
Burden
of Disease Study 2017. Lancet 2018;392:1859-922. doi:10.1016/
S0140-6736(18)32335-3
47 Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life
expectancy,
years of life lost, and all-cause and cause-specific mortality for
250
causes of death: reference and alternative scenarios for 2016-40
for 195 countries and territories. Lancet 2018;392:2052-90.
doi:10.1016/S0140-6736(18)31694-5
48 OECD Family Database. CO1.2: Life expectancy at birth.
https://www.
oecd.org/els/family/CO_1_2_Life_expectancy_at_birth.pdf
49 OECD.Stat. Health status. 2021.
https://stats.oecd.org/Index.
aspx?DataSetCode=HEALTH_STAT
50 National Center for Health Statistics. Life Tables. Vital
Statistics of the
United States, 1970; volume 11; section 5. https://www.cdc.gov/
nchs/data/lifetables/life70.pdf.
51. 51 Arias E. United States life tables, 2002. National Vital
Statistics
Reports; vol 53 no 6. National Center for Health Statistics,
2004;
volume 53, No 6.
52 Krieger N, Testa C, Hanage WP, Chen JT. US racial and
ethnic data
for COVID-19 cases: still missing in action.
Lancet 2020;396:e81.
doi:10.1016/S0140-6736(20)32220-0
53 APM Research Lab. The Color of Coronavirus: COVID-19
Deaths by
Race and Ethnicity in the US. 2021.
https://www.apmresearchlab.
org/covid/deaths-by-race
54 Kiang MV, Irizarry RA, Buckee CO, Balsari S. Every body
counts:
measuring mortality from the COVID-19 pandemic. Ann Intern
Med 2020;173:1004-7. doi:10.7326/M20-3100
55 Council on Foreign Relations. Improving Pandemic
Preparedness:
Lessons From COVID-19. Independent Task Force Report No
78.
Council on Foreign Relations, 2020.
56 Hanage WP, Testa C, Chen JT, et al. COVID-19: US federal
accountability for entry, spread, and inequities-lessons for the
future.
Eur J Epidemiol 2020;35:995-1006. doi:10.1007/s10654-020-
00689-2
52. 57 Altman D. Understanding the US failure on coronavirus-an
essay by
Drew Altman. BMJ 2020;370:m3417. doi:10.1136/bmj.m3417
58 Shokoohi M, Osooli M, Stranges S. COVID-19 pandemic:
what can the
West learn from the East?Int J Health Policy
Manag 2020;9:436-8.
doi:10.34172/ijhpm.2020.85
59 Yong E. How the pandemic defeated America.
Atlantic 2020;4.
60 Parker R. Why America’s response to the COVID-19
pandemic failed:
lessons from New Zealand’s success. Adm Law
Rev 2021;73:77-103.
61 WHO Regional Office for Europe, European Commission,
European
Observatory on Health Systems and Policies. COVID-19 Health
System Response Monitor.
https://www.covid19healthsystem.org/
mainpage.aspx
https://www.cdc.gov/coronavirus/2019-ncov/covid-
data/investigations-discovery/hospitalization-death-by-race-
ethnicity.html
https://www.cdc.gov/coronavirus/2019-ncov/covid-
data/investigations-discovery/hospitalization-death-by-race-
ethnicity.html
https://data.cdc.gov/NCHS/AH-Excess-Deaths-by-Sex-Age-and-
Race/m74n-4hbs
https://data.cdc.gov/NCHS/AH-Excess-Deaths-by-Sex-Age-and-
Race/m74n-4hbs
https://www.census.gov/newsroom/press-kits/2020/population-
55. 66 Preston S, Vierboom Y. Why do Americans die earlier than
Europeans?
The Guardian, May 4 2021.
67 Bassett MT, Chen JT, Krieger N. Variation in racial/ethnic
disparities
in COVID-19 mortality by age in the United States: A cross-
sectional
study. PLoS Med 2020;17:e1003402. doi:10.1371/journal.
pmed.1003402
68 Lopez L3rd, Hart LH3rd, Katz MH. Racial and Ethnic
Health Disparities
Related to COVID-19. JAMA 2021;325:719-20. doi:10.1001/
jama.2020.26443
69 Delgado R, Stefancic J. Critical Race Theory: The Cutting
Edge. Temple
University Press, 2013.
70 Jones CP. Systems of power, axes of inequity: parallels,
intersections,
braiding the strands. Med Care 2014;52(Suppl 3):S71-5.
doi:10.1097/MLR.0000000000000216
71 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N,
Bassett MT.
Structural racism and health inequities in the USA: evidence
and
interventions. Lancet 2017;389:1453-63. doi:10.1016/S0140-
6736(17)30569-X
72 Malat J, Mayorga-Gallo S, Williams DR. The effects of
whiteness on
the health of whites in the USA. Soc Sci Med 2018;199:148-56.
doi:10.1016/j.socscimed.2017.06.034
56. 73 Williams DR, Lawrence JA, Davis BA. Racism and health:
evidence
and needed research. Annu Rev Public Health 2019;40:105-25.
doi:10.1146/annurev-publhealth-040218-043750
74 Benjamins MR, Silva A, Saiyed NS, De Maio FG.
Comparison
of All-Cause Mortality Rates and Inequities Between Black
and White Populations Across the 30 Most Populous US
Cities. JAMA Netw Open 2021;4:e2032086. doi:10.1001/
jamanetworkopen.2020.32086
75 Bailey ZD, Feldman JM, Bassett MT. How Structural
Racism Works -
Racist Policies as a Root Cause of U.S. Racial Health Inequitie.
N Engl
J Med 2021;384:768-73. doi:10.1056/NEJMms2025396
76 Yancy CW. COVID-19 and African Americans.
JAMA 2020;323:1891-
2. doi:10.1001/jama.2020.6548
77 Egede LE, Walker RJ. Structural racism, social risk factors,
and
Covid-19 - a dangerous convergence for Black Americans. N
Engl J
Med 2020;383:e77. doi:10.1056/NEJMp2023616
78 Tan SB, deSouza P, Raifman M. Structural racism and
COVID-19
in the USA: a county-level empirical analysis. J Racial Ethn
Health
Disparities 2021;1-11.
79 Tipirneni R. A data-informed approach to targeting social
57. determinants of health as the root causes of COVID-19
disparities. Am J Public Health 2021;111:620-2. doi:10.2105/
AJPH.2020.306085
80 Lavizzo-Mourey RJ, Besser RE, Williams DR.
Understanding and
mitigating health inequities — past, current, and future
directions. N
Engl J Med 2021;384:1681-4. doi:10.1056/NEJMp2008628
81 Krieger N, Waterman PD, Chen JT. COVID-19 and overall
mortality
inequities in the surge in death rates by Zip code
characteristics:
Massachusetts, January 1 to May 19, 2020. Am J Public
Health 2020;110:1850-2. doi:10.2105/AJPH.2020.305913
82 Allen S, Julian Z, Coyne-Beasley T, Erwin PC, Fletcher FE.
COVID-19’s
impact on women: a stakeholder-engagement approach to
increase
public awareness through virtual town halls. J Public Health
Manag
Pract 2020;26:534-8. doi:10.1097/PHH.0000000000001249
83 Rubin R. As their numbers grow, COVID-19 “long haulers”
stump
experts. JAMA 2020;324:1381-3. doi:10.1001/jama.2020.17709
84 Verdery AM, Smith-Greenaway E, Margolis R, Daw J.
Tracking the
reach of COVID-19 kin loss with a bereavement multiplier
applied to
the United States. Proc Natl Acad Sci U S A 2020;117:17695-
701.
doi:10.1073/pnas.2007476117
58. Web appendix: Supplementary material
Web figure: Supplementary figure 1
Web figure: Supplementary figure 2
Web figure: Supplementary figure 3
https://ihpme.utoronto.ca/research/research-centres-
initiatives/nao/covid19/
https://ihpme.utoronto.ca/research/research-centres-
initiatives/nao/covid19/
https://www.multistate.us/issues/covid-19-policy-tracker
https://www.multistate.us/issues/covid-19-policy-tracker
https://www.oecd.org/coronavirus/en/