The COVID-19 pandemic, now entering its third year, has resulted in over 445 million confirmed cases of disease and six million deaths worldwide. By December 2021, more Americans had died during the COVID pandemic than during the 1918 influenza pandemic. The decline in life expectancy in the United States between 2018 and 2020 represents the largest drop since World War II.
Multiple factors have influenced the number of deaths due to COVID-19, including the development and distribution of vaccines and antiviral therapies, innovations in health care, mask use, and social distancing. However, survival rates also depend on the population's general health, which depends in part on long-term health-care trends. This begs the question: How did pre-pandemic health-care trends impact COVID-19 mortality rates?