Americans’ Health During the COVID-19 Pandemic

The COVID-19 pandemic has had a significant impact in Americans’ health. But the picture is nuanced and complex, impacting racial and ethnic groups and certain geographic areas differently, according to UnitedHealth Foundation’s 2021 America’s Health Rankings Annual Report.

Rhonda Randall, D.O.

“In this year’s report — which provides a comprehensive look at our nation’s overall health — we begin to see how the COVID-19 pandemic has had both direct and indirect impacts on health and health trends,” said Rhonda Randall, D.O., executive vice president and chief medical officer of UnitedHealthcare Employer and Individual, part of UnitedHealth Group, said in a statement.

The UnitedHealth Foundation is the philanthropic arm of the UnitedHealth Group.

The 2021 annual report examines 81 measures from 30 data sources to understand the impact that social, economic, environmental and other factors have on health. The report also includes a state-by-state analysis of the nation’s health.

The nation experienced a 17% increase in the overall U.S. death rate between 2019 and 2020, according to the CDC. The most recent data for 2021 data shows an even larger increase of 21% from pre-pandemic levels. COVID-19 was the third-leading cause of death in the country in 2020.

Additionally, the death rate from COVID-19 in 2020 was highest among the non-Hispanic American Indian/Alaska Native population, men, and adults ages 85 and older. COVID-19-related deaths among the Hispanic population, the Black population and the Hawaiian/Pacific Islander population also all exceeded the national rate.

And while certain trends — such as lack of sleep and binge drinking — were reversed in 2020, other trends showed uneven gain. In mental health, for example, overall frequent mental distress decreased 4% nationally, from 13.8% to 13.2%. But mental distress increased for some and varied widely across geography, race and ethnicity, age, education, income and gender in 2020.

It was 2.9 times higher among multiracial adults than Asian adults, 2.3 times higher among adults ages 25 and older with an annual household income less than $25,000 than those with an income of $75,000 or more and 1.5 times higher among females than males.

Although binge drinking declined by 5%, slightly more Americans reported heavy drinking, defined as eight or more drinks per week for women and 15 or more drinks per week for men. Data from the CDC show also that drug overdose deaths reached a record high of roughly 93,000 in 2020. In 2021, 12% of U.S. adults reported non-medical drug use, or using prescription drugs non-medically (including pain relievers, stimulants, sedatives) or illicit drugs (excluding cannabis) in the last 12 month.

United Health Foundation’s report also found that there has been a significant increase in public health funding nationwide and in each state — in part due to COVID-19 relief policy responses to this public health emergency. Funding increased 33% nationally between 2017-2018 and 2019-2020, from $87 to $116 per person. This includes increases in all 50 states and the District of Columbia by 12% or more.

Georges C. Benjamin, M.D.

“The pandemic has shown us how important it is to have a strong public health infrastructure to continue to address the challenges we face,” Georges C. Benjamin, M.D., executive director of the American Public Health Association, said in a statement. “It is my hope that we use this data to build a public health system that can work to protect all Americans and address health inequities.”

Other key findings include:

• Cancer: Nearly 16.7 million adults reported ever being told by a health professional that they had cancer in 2020. This is a 7% decrease nationally between 2019 and 2020, from 7.3% to 6.8%. This reverses a 3% increase in the cancer rate between 2018 and 2019 — and a 9% increase between 2016 and 2019.

Researchers from United Health Foundation speculate that this may be because there decline in routine cancer screenings due to the COVID-19 pandemic, with some cases of cancer and other chronic conditions going undiagnosed. Recent research has found that nearly two-thirds of patients scheduled for routine cancer screenings during the pandemic skipped their visits and that breast cancer and cervical cancer screening rates declined by 87% and 84%, respectively, when comparing April 2020 with the five previous years.

• Chronic conditions: Multiple chronic conditions varied by race and ethnicity and also reveal wide disparities across states. In 2020, the rate of multiple chronic conditions was about five times higher among American Indian/Alaska Native and multiracial adults than Asian adults. It was also 2.9 times higher in West Virginia than in Hawaii, the states with the highest and lowest rates, respectively.