Man looking out of window, Manhattan, New York, USA

Vulnerable Older Americans Aren’t Getting Adequate Care—Even With Paid Caregivers or Grown Children

Half of older parents who need daily care at home have unmet needs, and those with stepchildren are less likely to get help from their kids. Other at-risk groups include those with in-home caregivers or dementia, new studies show.

Half of older American parents who need help at home with daily activities are not getting that assistance, new analysis of the nationally representative National Health and Aging Trends Study (NHATS) data shows.1

“We find that unmet needs are quite high among older adults with care needs,” says Sarah Patterson of the University of Michigan’s Population Studies Center and lead author of the study. Unmet needs refer to going without things like showering, getting dressed or having clean laundry, or eating hot meals because of a lack of help, she explains.

Older people with paid in-home caregivers are more likely to go without such help than their peers in residential care facilities and are more likely to miss medication, sit in soiled clothing, or skip meals, finds another new study of the NHATS data.2 And older people with dementia face an especially high risk of unmet need, a third new study shows.3

Spouses and adult children provide most of the care for older Americans who need help; however older adults in stepfamilies are half as likely to get help from adult children than those with only biological children, a difference Patterson and colleagues call the “step gap” (see figure).


FIGURE. Older Parents With Only Biological Children Are More Than Twice as Likely to Receive Care From Their Adult Children Than Those in Stepfamilies

Source: Sarah E. Patterson et al., “Care Received and Unmet Care Needs Among Older Parents in Biological and Step Families,” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 77, Supplement 1 (2022): S51-62.


“The step gap may show up because of complex relationships within stepfamilies, but it could also reflect a dilution in resources,” explains Patterson. “When there is remarriage, there are simply more parents who need care—pulling some adult children in multiple directions and forcing them to choose whom to support based on the time and money they have available.

“In the future, parents may have to shift how they find care—that is, begin to change their expectations of their children and instead rely on friends or other sources of care,” she suggests.

Older Adults With Paid Home Caregivers Are More Likely to Have Unmet Needs Than Those in Residential Care

Older adults receiving paid care in their homes face twice the odds of experiencing the consequences of unmet need than those living in residential care settings, such as a personal care homes or assisted living facilities, Meghan Jenkins Morales and Stephanie Robert of the University of Wisconsin – Madison find.4

Their study used 2015 and 2017 NHATS data to explore the relationship between negative consequences of unmet need and type of care arrangement, focusing on older adults receiving assistance with at least one self-care, mobility, or household activity because of their health or physical functioning.

In both years, the risk of having persistent unmet needs for care was more than four times higher among older adults receiving paid care in their homes compared with their peers in residential facilities.

Improving paid care arrangements to meet the needs of older adults should be a top priority, Jenkins Morales and Robert argue.

“Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to other care arrangements,” they write. Simple solutions such as installing grab bars and shower seats could improve access and independence, particularly for those who may be less comfortable receiving help bathing, they note.

Often, unmet needs involve not receiving enough hours of care or receiving poor quality care or care that does not match individual needs, such as help with laundry but not food preparation. Evidence shows that care is often insufficiently coordinated and that better communication among paid and unpaid caregivers and other health care providers is needed, they report.

Because of high costs, residential care is usually only an option for older adults with significant financial resources, Morales and Robert point out. Their findings can “provide additional impetus for advocates and policymakers to consider how to promote equitable access to quality residential care,” they argue.

Older Adults With Lower Incomes and Dementia Are More Likely to Face Consequences of Unmet Need

Due to the long and costly course of dementia, older adults with the condition often deplete their financial resources and ultimately become dual-enrollees, or participants in both Medicaid and Medicare, says Chanee Fabius of Johns Hopkins University.5 Dual enrollees typically have more limited financial resources and social support than those on Medicare alone, she explains.

Their study used 2011 to 2015 NHATS data on dual-enrollees with disabilities living in the community rather than residential care facilities.  Among those receiving paid help, those with dementia faced higher odds of experiencing adverse consequences related to unmet care needs than those without dementia, they found. In addition, those with dementia were more likely to use paid help if they lived in a state with more generous Medicaid-related home- and community-based services.

These findings underscore the complexity of supporting dual-enrollees with dementia living in the community, Fabius explains.

Although Medicaid has shifted funds from nursing home services to home-based services, more than 700,000 people were on waitlists in 40 states in 2017, she reports. “Dual-enrollees may be unable to afford all the care they need, particularly the extensive assistance needed by people with more advanced dementia,” she says.

“Caregiving is often a collaborative effort between paid helpers and family and other unpaid caregivers,” she says, seconding Jenkins Morales and Robert’s call for better coordination and communication among those providing care.

“When there are gaps in care, family and unpaid caregivers are often left to help, especially those assisting an older adult living with dementia,” Fabius reports. “Caregivers may feel unprepared for this role and may be juggling other responsibilities, such as child care and paid employment.”

Fabius says the findings also demonstrate the need for more generous and accessible Medicaid home- and community-based services for low-income people with dementia, including expanded training and wage increases for paid caregivers.

Older People in Stepfamilies Are Less Likely to Receive Help From Adult Children

Increases in divorce and remarriage and declines in fertility mean that older parents today have fewer biological children and more stepchildren than previous generations, Patterson reports. “About one in eight older adults with activity limitations has a stepchild,” she says.

Adult children may feel less obligated to care for elderly stepparents or for parents they did not live with during childhood, Patterson notes.

Older adults in need of care who have only biological children are more than twice as likely to receive care from their adult children than older adults with any stepchildren, Patterson and colleagues show (see figure).6 Despite this “step gap,” they found the same high rate of unmet needs—about 50%—among the two groups.

“We know that family relationships don’t exist in isolation—we all operate within a family system,” says Patterson. “When research only looks at individual relationships, like between a mother and a daughter, it might miss the dynamics of the larger family system.”

The researchers used 2015 NHATS data on more than 2,000 older parents, examining the kind of care they receive, including who is providing care and whether they have unmet needs. The researchers also considered whether the parents received any paid care over the previous month, whether they were married or living with a partner, and whether they had received care from their partner over the previous month.

Even among those with partners who could care for them, older adults with only biological children were more likely to receive help from their adult children than those with a stepfamily, they found. But those living with partners had the same level of unmet need, whether they had any stepchildren or just biological children.

“Even if older people have a partner or an adult child to care for them, older adults in the U.S. still have high rates of unmet need for care,” Patterson says. “Partners and children are seen as front-line caregivers. We expect they will take care of older family members, and I think what our study says is that partners and children might need help doing so.”

That help could take many forms, from programs offering respite care and home modifications to skills training and counseling on benefits. Policies such as paid family leave, paid sick leave, and tax credits to help cover family caregiving expenses could make a difference, she notes.


[1] Sarah E. Patterson et al., “Care Received and Unmet Care Needs Among Older Parents in Biological and Step Families,” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 77, Supplement 1 (2022): S51-62.

[2] Meghan Jenkins Morales and Stephanie A. Robert, “Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum,” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 77, Supplement 1 (2022): S63–73.

[3] Chanee D. Fabius et al., “Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia,” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences (2022).

[4] Morales and Robert, “Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum.”

[5] Fabius et al., “Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia.”

[6] Patterson et al., “Care Received and Unmet Care Needs Among Older Parents in Biological and Step Families.”

PRB-West Africa-Jumbo

PACE Joins Renowned Institutions in West Africa to Strengthen the Connection Between Research and Practice

Policy Fellows program expands from individuals to form institutional partnerships, promoting local leadership and sustainability.

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Since the 1980s, PRB’s Policy Fellows program has been grounded in the belief that while research often has profound policy implications, it must be communicated effectively to a variety of nontechnical audiences to have an impact. The program, with nearly 400 alumni from 65 countries, builds the skills of young researchers, typically Ph.D. students, to translate evidence into action.

Until recently, PRB administered the Policy Fellows program as an individual capacity strengthening initiative, preparing fellows for effective policy communication leadership wherever their careers may take them. Fellows complete an intensive training course based on the policy communication toolkit of the USAID-funded PACE project, which focuses on population and reproductive health. Today, many former fellows hold successful careers in the policy space, and many also serve in leadership roles.

However, PRB recognized that involving institutions in the program would help promote local leadership and sustainability. In 2020, PACE rolled out the program in Francophone Africa under a new vision: to cultivate teams of policy communication experts based at regional universities and research institutions who can then directly administer the training year after year.

To build our institutional partnerships, PRB explored and received interest in the program from three prominent West African research institutions: the Higher Institute of Population Sciences (Burkina Faso); the Institute for Demographic Training and Research (Cameroon); and the Institute of Population, Development, and Reproductive Health (Senegal). The Ouagadougou Partnership Coordination Unit, a partnership that supports the nine Francophone countries in West Africa to accelerate the implementation of family planning interventions, and PACE selected 15 Policy Fellows from the region, including graduate students at the partner institutions. Participants, representing five Ouagadougou Partnership countries and Cameroon, conducted research on demographic transitions, family planning and reproductive health, and maternal and child health.

Facilitators for the program, alongside PACE, were identified from faculty at each of the three institutions. Professor Parfait Eloundou-Enyegue, a renowned demographer at Cornell University and a Policy Fellows alumnus, taught the facilitators how to administer PRB’s training using an innovative teaching method—designed in collaboration with the three professors to reinforce the professional relationship between the students and professors in a Francophone context.

The trained facilitators, PACE, and the Ouagadougou Partnership co-hosted a virtual policy communication training for the 15 fellows from October 22 through Nov. 6, 2020. The training was followed by six months of practical work during which students wrote scientific articles and produced analyses of political landscapes, presenting them during discussions with policy decisionmakers.

In August 2021, PRB advanced the program with a training-of-trainers led by Professor Eloundou-Enyegue, working with teams of 2020 program fellows affiliated with the Institute for Demographic Training and Research (IFORD), the Higher Institute of Population Sciences (ISSP), and the Center of Excellence for Research in Generational Economics (CREG), based in Senegal. Over the next eight months, IFORD, ISSP, and CREG each adapted the training materials for their local contexts and priorities and cascaded the training to Ph.D. and master’s-level students and professionals in their respective institutions, with PACE providing technical support, mentoring, and feedback to course facilitators. The Policy Fellows program was also expanded to institutions in Anglophone Africa.

This transitioned approach enabled PRB’s policy communication methods to reach actors at multiple levels of the policy development process. While ISSP and IFORD train the current and next generation of researchers and civil servants, respectively, CREG reaches senior researchers who already occupy positions as advisers to decisionmakers. In a promising sign for sustainability, all three institutions plan to offer the program independently in future years, long after the end of the PACE project.

The integration of PACE’s policy communication modules in the curriculum of three renowned institutions revealed an appetite to strengthen the interface between research and practice and informed policy change in West Africa. Gervais Beninguisse, a professor at IFORD, explained: “This training provides significant added value in the face of the gap observed among graduates who are called upon to play a role in steering the statistical information systems of their countries, as well as in the face of the persistent and worrying insufficiency of the use of research results to enlighten the decision-making processes in the area of public policy in Francophone Africa.”

PRB-West Africa-Jumbo

PACE s'associe à des institutions renommées en Afrique de l'Ouest pour renforcer le lien entre la recherche et la pratique

Le programme de Communication pour les Politiques s'étend au-delà des individus pour former des partenariats institutionnels, renforçant le leadership local et la durabilité.

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Depuis les années 1980, le programme de Communication pour les Politiques de PRB est ancré dans la conviction que si la recherche a souvent de profondes répercussions sur les politiques, elle doit être communiquée efficacement aux divers publics non techniques pour avoir un impact. Le programme, qui a formé près de 400 étudiants issus de 65 pays, renforce les compétences de jeunes chercheurs, généralement des doctorants, afin qu’ils puissent traduire les données en actions.

Jusqu’à récemment, PRB a administré ce programme comme une initiative de renforcement des capacités individuelles, préparant les étudiants à un leadership efficace en matière de communication pour le changement politique, où que leur carrière les mène. Ces derniers ont suivi un cours intensif basé sur la boîte à outils de communication pour les politiques du projet PACE, financé par l’USAID, qui se concentre sur la population et la santé reproductive. Aujourd’hui, de nombreux anciens étudiants mènent une carrière réussie dans la sphère des politiques publiques, et nombre d’entre eux occupent également des fonctions de direction.

Cependant, PRB a reconnu que l’implication des institutions de recherche dans le programme contribuerait à promouvoir le leadership local et la durabilité. En 2020, PACE a déployé le programme en Afrique francophone suivant une nouvelle vision : cultiver des équipes d’experts en communication pour les politiques, basées dans les universités et les institutions de recherche régionales pouvant ensuite dispenser directement la formation année après année.

Pour établir ses partenariats institutionnels, PRB a exploré et suscité l’intérêt de trois institutions de recherche ouest-africaines de renommée : l’Institut supérieur des sciences de la population (ISSP – Burkina Faso) ; l’Institut de formation et de recherche démographiques (IFORD – Cameroun) ; et l’Institut de la population, du développement et de la santé reproductive (IPDSR – Sénégal). L’Unité de Coordination du Partenariat de Ouagadougou (UCPO), soutenant les neuf pays francophones d’Afrique de l’Ouest pour accélérer la mise en œuvre des interventions de planification familiale, et PACE ont sélectionné quinze doctorants de la région, incluant des étudiants diplômés des institutions partenaires. Les participants, représentant cinq pays du Partenariat de Ouagadougou et le Cameroun, menaient des recherches sur les transitions démographiques, le planning familial et la santé reproductive, ainsi que la santé maternelle et infantile.

Les enseignants du programme, aux côtés de PACE, ont été identifiés parmi les professeurs de chacune des trois institutions. Le professeur Parfait Eloundou-Enyegue, démographe de renom à l’université de Cornell et ancien étudiant du programme de communication pour les politiques, a préparé les enseignants à dispenser la formation de PRB suivant une méthode pédagogique innovante – conçue en collaboration avec les trois professeurs pour renforcer la relation professionnelle entre étudiants et professeurs dans un contexte francophone.

Les enseignants formés, PACE, et l’UCPO ont co-organisé une formation virtuelle en communication pour les politiques pour les quinze doctorants du 22 octobre au 6 novembre 2020. La formation a été suivie de six mois de travaux pratiques au cours desquels les étudiants ont rédigé des articles scientifiques, produit des analyses de paysages politiques et les ont présentées lors de discussions avec des décideurs.

En août 2021, PRB a fait évoluer le programme avec une formation de formateurs dirigée par le professeur Eloundou-Enyegue, travaillant avec des équipes d’étudiants du programme 2020 affiliés à l’IFORD, l’ISSP et au Centre d’excellence pour la recherche en économie générationnelle (CREG – Sénégal). Au cours des huit mois suivants, l’IFORD, l’ISSP et le CREG ont chacun adapté le matériel de formation à leur contexte et priorités locales et ont dispensé la formation à des étudiants de niveau doctorat et master et des professionnels dans leurs institutions respectives, PACE fournissant un soutien technique, un encadrement et un retour d’information aux enseignants. Le programme de communication pour les politiques a également été étendu aux institutions d’Afrique anglophone.

Cette approche transitionnelle a permis aux méthodes de communication pour les politiques de PRB d’atteindre les acteurs à plusieurs niveaux du processus d’élaboration des politiques. Alors que l’ISSP et l’IFORD forment respectivement la génération actuelle et la prochaine génération de chercheurs et de fonctionnaires, le CREG touche les chercheurs seniors qui occupent déjà des postes de conseillers auprès des décideurs. Signe prometteur pour la durabilité, les trois institutions prévoient de dispenser le programme de manière indépendante dans les années à venir, bien après la fin du projet PACE.

L’intégration des modules de communication pour les politiques de PACE dans le cursus de trois institutions renommées a révélé un appétit pour renforcer l’interface entre la recherche et la pratique, et le changement de politique informé en Afrique de l’Ouest. Gervais Beninguisse, professeur à l’IFORD, explique : “Cette formation apporte une valeur ajoutée significative face au déficit observé chez les diplômés appelés à jouer un rôle dans le pilotage des systèmes d’information statistique de leurs pays, ainsi que face à l’insuffisance persistante et préoccupante de l’utilisation des résultats de la recherche pour éclairer les processus de décision en matière de politiques publiques en Afrique francophone.”


Appalachia Data Report Identifies Economic Gains, Key Gaps Heading Into COVID Pandemic

Longstanding vulnerabilities suggest some groups in the Appalachian Region are at risk for greater hardship during the pandemic.

Prior to the COVID-19 pandemic, Appalachia’s median household income and labor force participation were both on the rise, and poverty rates were declining. But longstanding vulnerabilities suggest that some groups in the Appalachian Region risked greater hardship related to the pandemic, including older adults with disabilities, households without internet access, and residents of the Region’s most rural counties.

The Appalachian Region: A Data Overview From the 2016-2020 American Community Survey, a new PRB report for the Appalachian Regional Commission, provides a comprehensive picture of social and economic conditions in Appalachia before and during the first 10 months of the COVID-19 pandemic. As more data from the pandemic and post-pandemic periods become available in the coming years, this report can serve as a benchmark of comparison for future analysis.

“Although the report data do not measure the pandemic’s social and economic impact beyond 2020, they do allow Appalachian program planners and policymakers to pinpoint areas and population subgroups most at risk and enable them to better target assistance,” said Kelvin Pollard, senior demographer at PRB, who coauthored the report with Linda A. Jacobsen, PRB senior fellow.

Drawing from the latest American Community Survey and U.S. Census Bureau Population Estimates, the report contains more than 300,000 data points comparing Appalachia’s regional, subregional, state, and county levels with the rest of the nation.

Appalachia’s Economy Was Improving Before COVID-19

During the 2016-2020 period (which includes the four years leading up to the pandemic), Appalachia was improving across several measures. Data suggest that much of the Region had finally recovered from the 2007-2009 recession, though this recovery was slower than in most of the nation.

  • Median household income increased nearly 10% between 2011-2015 and 2016-2020, with 83 of 423 Appalachian counties throughout the Region experiencing increases of at least 15%.
  • Appalachia’s overall poverty rate (14.7%) decreased 2.4 percentage points between 2011-2015 and 2016-2020.
  • Labor force participation (73.8%)—though 4 percentage points lower than the national average—increased by 1.1 percentage points between 2011-2015 and 2016-2020, surpassing the national increase of 0.8 percentage points.

Another bright spot is that Appalachia’s residents are slightly less likely to be without health insurance at nearly all ages than other U.S. residents; young adults ages 26 to 34 are the only exception.

Pandemic May Be Compounding Disadvantages Related to Poverty, Aging, Disability, and Lagging Internet Access

Despite positive trends, the report revealed vulnerabilities that may have been exacerbated by the COVID-19 pandemic’s health, social, and economic impacts.

  • Regional poverty rates have declined overall, but rates have stayed the same or increased in 85 Appalachian counties.
  • Fewer Appalachian households had a broadband subscription compared with households elsewhere in the nation (80.7% compared with 85.2%). In 26 Appalachian counties, the prevalence of subscriptions was less than 65%. This digital divide, even within the Region itself, impacts residents’ access to remote work, online learning, telehealth, and more.
  • The percentage of Appalachian households receiving payments from the federal Supplemental Nutrition Assistance Program (SNAP) (formerly known as Food Stamps) was higher (more than 13%) compared to non-Appalachian households (more than 11%), with households in Central Appalachia reaching almost 21%. For households with children under age 18, Appalachia’s SNAP participation rate is higher than the national rate (21% v. 18%).
  • The proportion of working-age adults (ages 25 to 64) with a bachelor’s degree was 15.8% in Central Appalachia, 18.2% in rural Appalachian counties, and 26.9% Region-wide, compared with 34.3% nationally.
  • Nearly three-fourths (73.8%) of Appalachia’s working-age adults were in the labor force compared with 78.2% nationwide. Only 60.5% were in the labor force in Central Appalachia. Counties with higher labor force participation rates also tend to have higher levels of educational attainment.
  • The share of Appalachia’s residents ages 65 and older was just over 19% in 2020, more than 2 percentage points above the national average. Additionally, the share of Appalachians ages 65 and older with a disability was more than 3 percentage points higher than the national rate.

“With persons ages 65 and older particularly vulnerable to COVID-19 complications, communities with the largest share of older adults have similarly been at risk of higher illness and death rates because of the pandemic,” Pollard points out.

Rural Appalachia More Disadvantaged Than the Rest of the Rural United States

The report’s data show that not only are Appalachia’s rural areas more vulnerable than its urban areas, but the Region’s 107 rural counties also face greater disadvantages than 841 similarly designated rural counties in the rest of the country.

  • Population decline was much faster in rural Appalachia between 2010 and 2020 than in rural counties in the rest of the country—3% versus 0.6%.
  • Educational attainment among adults ages 25 to 64 in rural Appalachia lagged about 4 percentage points behind that in rural counties outside the Region in 2016-2020, both in terms of high school and college completion.
  • At $42,403, median household income in rural Appalachian counties was about $9,500 lower than median income in rural counties outside the Region. In rural Appalachia, 20% of residents live in poverty compared with 15.4% in the rest of the rural United States.
  • Housing stock also differed: Mobile homes made up nearly 20% of residences in rural Appalachia compared with just under 12% in the rest of the rural United States.
  • As was true with Appalachia as a whole, labor force participation in the Region’s rural counties was lower than in rural counties outside the Region (65% v. 74%).
  • Workers in rural Appalachia were also much more likely to work outside their county of residence (32% v. 20%) and have commutes of 30 minutes or more (31% v. 22%).
  • The digital divide was wider in rural Appalachian counties than elsewhere in the rural United States. More than one-fifth of rural Appalachian households (22%) had no internet access—4 percentage points higher than in other rural counties. And the share with at least 1 computer device in the household (83%) and the share with a broadband subscription (74%) were both more than 4 percentage points lower in rural Appalachia. With most schools closed throughout much of 2020 due to the COVID-19 pandemic, this rural digital divide likely made online education even more challenging for children in Appalachia’s rural counties.
  • Disability rates were higher in rural Appalachia than in other rural areas of the country (20% v. 16%). Indeed, they were higher among all age groups, with at least a 5-percentage point gap among residents ages 35 to 64 and ages 65 and older.
  • SNAP participation rates in rural Appalachia were also higher than in rural areas outside the Region (17% v. 13%). More than one-fourth of households with children in rural Appalachia (26%) received SNAP benefits compared with slightly more than one-fifth of households with children in the rest of the rural United States (21%).

“The report indicates that conditions were already more challenging in rural Appalachia up through the first 10 months of the pandemic than in rural areas outside the Region. These data also provide an important baseline for future assessments of the differential impact of the pandemic on rural Appalachia compared with rural areas in the rest of the country,” says Jacobsen.

The Appalachian Region encompasses 206,000 square miles along the Appalachian Mountains from southern New York to northern Mississippi, including portions of 12 states and all of West Virginia.

The Appalachian Regional Commission report uses data from the 2016-2020 American Community Survey and the Census Bureau’s vintage 2020 population estimates—the most recent data available for the characteristics studied. It includes detailed tables and county-level maps covering state- and county-level data on population, age, race and ethnicity, housing occupancy and tenure, housing type, education, computer ownership and internet access, labor force participation, employment and unemployment, transportation and commuting, income and poverty, health insurance coverage, disability status, migration patterns, and veteran status. It also includes a detailed comparison of characteristics in rural Appalachian counties with those outside the Region.

About the Appalachian Regional Commission

The Appalachian Regional Commission is an economic development agency of the federal government and 13 state governments focusing on 423 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the Region achieve socioeconomic parity with the nation.

0823 CA Deaths Background

Hispanic, Black, and Asian Californians Saw Disproportionately Large Drops in Life Expectancy During COVID Pandemic

Study shows stark differences in life expectancy loss between Californians living in high- and low-income areas during the COVID-19 pandemic

The life expectancy of Californians has decreased by about three years as a result of the COVID-19 pandemic, according to a study by National Bureau of Economic Research (NBER)-affiliated researchers and colleagues published in the Journal of the American Medical Association.1

The research shows that life expectancies for Hispanic, Black, and Asian Californians decreased more than for white Californians (see Figure 1). Hispanic populations in California lost 5.7 years of life expectancy between 2019 and 2021, while Black populations lost 3.8 years, Asian populations lost 3.0 years, and white populations lost 1.9 years, according to the study led by Hannes Schwandt, a Northwestern University professor and NBER affiliate.

FIGURE 1. Latino, Black, and Asian Californians Saw Significant Drops in Life Expectancy During the COVID-19 Pandemic

Change in Life Expectancy (in Years) in California by Race/Ethnicity, 2019-2021

Note: Black, Asian, and white categories are non-Hispanic.

Source: Hannes Schwandt et al., “Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021,” JAMA 328, no. 4 (2022): 360-66, doi:10.1001/jama.2022.10952.


 “In California, Hispanic individuals have historically lived longer than white individuals, but the pandemic upended that, as the life expectancy for Hispanic Californians decreased by about six years, three times as high as the decline for white Californians,” said co-author Jonathan Kowarski, a University of California, Los Angeles doctoral student in economics.

The study also found that life expectancy for those living in the lowest-income census tracts fell by nearly five years between 2019 and 2021 (from 75.9 to 71.1 years) compared with less than one year for those living in the highest-income census tracts (from 87.4 to 86.6 years) (see Figure 2). The gap in life expectancies between the two groups grew, from a difference of about 11.5 years before the pandemic to more than 15 years in 2021. During this time, income also became more tightly correlated with life expectancy than it had been previously.

FIGURE 2. Low-Income Neighborhoods in California Saw Significant Drops in Life Expectancy During the COVID-19 Pandemic

Change in Life Expectancy Since 2019 (in Years) in California Census Tracts With Lowest and Highest Median Household Incomes
Figure 2-ca-income-drops-life-expect

Source: Schwandt et al., “Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021,” JAMA 328, no. 4 (2022): 360-66.


“We’ve had indications that the pandemic affected economically disadvantaged people more strongly, but we never really had numbers on actual life expectancy loss across the income spectrum,” said Schwandt. “I am shocked by how big the differences were and the degree of inequality that they reflected.”

In their analysis of 1.9 million deaths in California between 2015 and 2021, the research team calculated that life expectancy for Californians fell from 81.4 years in 2019 to 79.2 years in 2020, and down to 78.4 years in 2021. This study demonstrates that the reduction in life expectancy continued from 2020 into 2021, despite the availability of vaccines for much of 2021.

Life expectancy is not the average life span of individuals in a society, but a hypothetical measure based solely on the mortality rates observed in a given year. It estimates how long a cohort of newborns could expect to live if it experienced the mortality rates of that specific year throughout their entire lifetimes.

In the current study, life expectancy captures how much life was lost collectively within a population during the pandemic years, and it illustrates the dramatic differences in the pandemic’s impact across communities of different socioeconomic status.

“Our results highlight the disproportionate burden the pandemic placed on low-income people and people of color,” said study co-author Janet Currie, a Princeton University professor and NBER affiliate.

The study is based on an analysis of restricted death data obtained from the California Comprehensive Death Files maintained by the California Department of Health.

“Our findings are another troubling sign of how the pandemic’s impact was not felt evenly across all communities,” said study co-author Till von Wachter, a UCLA professor and NBER affiliate. “Policymakers can use these findings to craft a more equitable response now and also to inform how we plan for future public health crises.”

This article is based on pieces written by Sean Coffey of the California Policy Lab and Max Witynski of Northwestern University.



1 Hannes Schwandt et al., “Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021,” Journal of the American Medical Association 328 no. 4 (2022): 360-66, doi:10.1001/jama.2022.10952.

PRB Annual Report 2021

Letter from the CEO

Fiscal Year 2021 was a record-setting year for PRB, with revenues topping $15 million as a result of strong growth in both our domestic and international portfolios.

Such results are heartening in the best of times and truly extraordinary in this period of persistent uncertainty as COVID-19 continues to impact our work landscape.


This growth allowed us to make progress in important areas that are laying the groundwork for our long-term sustainability, including initiatives to strengthen our commitment to diversity, equity, and inclusion (DEI), investments in business development and product development, and the commencement of our strategic planning process. Thanks to the continued support of our major funders, we were able to explore new opportunities, test different models for how we operate, and grow and expand our presence and impact in East Africa and West Africa.

While we anticipate these efforts will bear fruit over the long-term, we expect the next few years to be challenging. Not only are several major contracts coming to an end but, like many organizations in our sector, we’re being impacted by a rapidly shifting funding environment. We expect much of our future growth will come from new and different types of opportunities, guided by the strategy now under development.


Jeff Jordan, CEO and President

Annual Report MLE-1920-01


PRB has made significant progress on our journey to become a more diverse and inclusive organization. We created an internal, staff-driven DEI Task Force that initiated a staff survey to inform our thinking and provide a baseline for measuring how we’re doing. We also brought in external consultants to assess our policies and culture and to coach and train staff and supervisors.

To ensure the sustainability of these efforts, we created a permanent DEI Council responsible for driving DEI activities and processes. We also strengthened our Human Resources (HR) function, rebranding the department as People & Culture and upgrading the HR director position to assistant vice president (AVP). The AVP of People & Culture is charged with fostering a culture of accountability, diversity, equity and inclusion, recognition, and trust among staff at all levels, and will measure and track progress on DEI initiatives, activities, and milestones.

PRB also announced support for the Coalition for Racial and Ethnic Equity in Development (CREED), a collective of U.S.-based international development and humanitarian assistance organizations committed to building racial and ethnic equity within our own policies, systems, and culture. At the center of these efforts is the CREED Pledge for Racial & Ethnic Equity in Development, for which PRB became a First Endorser. By signing the pledge, we’ve signaled that PRB and our leadership are committed to taking action to advance racial and ethnic equity, which includes integrating equity into our policies and culture.


The decolonization of aid and the relationships between international nongovernmental organizations and country-level partners is bringing significant change to the field of global development. PRB’s global engagement initiative is being led by our teams in Dakar, Senegal (West Africa and Central Africa) and Nairobi, Kenya (East Africa).


Our planned soft return to the Washington, DC, office was postponed to Fiscal Year (FY) 2022. Like many organizations, PRB will embrace a post-COVID hybrid work model, with most staff working remotely at least part of the time. Having negotiated an early end to our current lease at 1875 Connecticut Avenue, we began a search for space that would reduce our physical footprint and result in a significant cost savings. We expect to finalize our new Washington, DC, area location by the end of FY22.


If you ever have the opportunity to talk with PRB staff or visit our website, you will fast be reminded of the importance of our work and how it makes a difference. In FY21, PRB produced 184 digital, editorial, graphic, and video products in support of partner- and donor-funded activities. This work includes 36 products in languages including English, French, Hausa, and Hindi. By offering new ideas and fresh approaches, PRB has risen above the ordinary to provide our funders and partners with the tools and strategies to communicate effectively about complex and highly technical issues.



FY22 will be a year of positive disruption for PRB as we examine every aspect of the way we work and the type of organization we intend to be. Change is nothing new at PRB—an organization doesn’t remain successful for nearly a century without periodically reassessing its role and purpose in the world and making adjustments. And while transitions are never easy, we intend to use this time to be thoughtful and creative about our future. We know our success depends on our ability to evolve to meet the shifting dynamics of our sector and our world. These shifts mean we must stretch ourselves beyond our historic boundaries to embrace new approaches and ways of working and better integrate the skills and competencies of staff from across our international, domestic, and communications portfolios. Yes, we face uncertainties. But as we look ahead, we see a future for this organization that is bright and filled with exciting opportunities.


  • Actionable Insights, LLC
  • Annie E. Casey Foundation
  • Appalachian Regional Commission
  • Association of Monterey Bay Area Governments
  • AstraZeneca Young Health Programme
  • Bill & Melinda Gates Foundation
  • David and Lucile Packard Foundation
  • Education Sub-Saharan Africa
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Georgetown University-Institute for Reproductive Health
  • Hubert H. Humphrey Fellowship Program, Emory University, Rollins School of Public Health
  • John D. and Catherine T. MacArthur Foundation
  • Lucile Packard Foundation for Children’s Health
  • LVCT Health
  • Michigan Center on the Demography of Aging, University of Michigan
  • Nihal W. Goonewardene
  • NORC at the University of Chicago
  • The Palladium Group
  • Population Council
  • Southern California Association of Governments
  • UnidosUS
  • United Nations Population Fund
  • United States Agency for International Development
  • United States Census Bureau
  • William and Flora Hewlett Foundation

PRB worked together with 108 organizations in 2021.

  • Advance Family Planning
  • African Institute for Development Policy (AFIDEP)
  • African Population and Health Research Center (APHRC)
  • African Union Commission, Human Resources & Youth Division
  • Alliance Nationale des Jeunes pour la Santé de la Reproduction et la Planification Familiale (ANJSR/PF)
  • American Association for the Advancement of Science
  • Ariadne Labs
  • Association des Gestionnaires pour le Développement
  • L’Association des Journalistes et Communicateurs en Population et Développement (AJCPD)
  • Association of African Universities
  • Association Burkinabé pour le Bien-Etre Familial (ABBEF)
  • Association des Femmes Juristes de Côte d’Ivoire
  • Association Ivorienne pour le Bien-Etre Familial (AIBEF)
  • Association of Population Centers
  • Avenir Health
  • The Balanced Stewardship Development Association (BALSDA)
  • Berkley Center for Religion, Peace, and World Affairs, Georgetown University
  • Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
  • Break-Free From Plastic Initiative
  • Bridge Connect Africa Initiative (BCAI)
  • Blue Ventures
  • Cadre des Religieux pour la Santé et le Développement (CRSD)
  • Center for Excellence in Journalism (Karachi, Pakistan)
  • Centre for Enhancing Democracy and Good Governance (CEDGG)
  • Centre for Rights Education and Awareness (CREAW)
  • Centre Régional de Recherche en Economie Générationnelle (CREG)
  • Coalition for Health Promotion and Social Development
  • College of Medicine, University of Ibadan
  • Communications Consortium Media Center
  • Community Empowerment and Development Centre (CEDC)
  • Community Safety Initiative Kenya (CSI Kenya)
  • Conservation International (CI)
  • Converge Development Consultants Ltd
  • Developing Radio Partners
  • Digital Data System for Development, Nepal
  • Deutsche Stiftung Weltbevölkerung (DSW)
  • Direction de la Santé de la Mère et de l’Enfant (DSME) of the Ministry of Health and Social Action (MOHSA), Senegal
  • Durrell Wildlife Conservation Trust
  • Ecole Supérieure de Journalisme, des Métiers de l’internet et de la Communication (E-jicom)
  • Education Sub Saharan Africa
  • Family Planning 2030
  • FHI 360
  • Food and Agriculture Organization of the UN (FAO)
  • Global Women’s Institute
  • GOAL Malawi
  • Green Girls Platform
  • Groupe de volontaires pour la promotion de la maternité sans risques (GVP-MASAR)
  • Harvard University, Harvard Center for Population & Development Studies
  • Hen Mpoano
  • I Choose Life – Africa
  • Instituto Promundo
  • Institut de Formation et de Recherche Démographiques (IFORD)
  • Institute of Public Finance Kenya (IPFK)
  • Institut Supérieur des Sciences de la Population (ISSP)
  • Institut Supérieur des Sciences de la Population, Université de Ouagadougou (IPDSR)
  • International Center for Research on Women
  • International Crane Foundation
  • International Social Survey Programme
  • International Union for the Conservation of Nature (IUCN)
  • International Youth Alliance for Family Planning (IYAFP)
  • JSI Research & Training Institute Inc. (JSI)
  • Johns Hopkins Center for Communication Programs (JHU CCP)
  • Kenya National Council for Population and Development, Ministry of Devolution & Planning
  • Kenya Reproductive & Maternal Health Services Unit, Ministry of Health
  • Ladder for Rural Development Organization (LAFORD)
  • Legacy for African Women and Children (LAWANCI)
  • Linda Arts Organization
  • Margaret Pyke Trust
  • Middle-Space Multi-links Concept Ltd
  • Ministry of National Development Planning, Population, and Development Department (Zambia)
  • National Council for Tertiary Education (Ghana)
  • The National Opinion Research Center at the University of Chicago
  • National Population Council Ghana
  • National Population Council Uganda
  • The Nature Conservancy
  • Novel Association for Youth Advocacy (NAYA)
  • O’Hare Data and Demographic Services, LLC
  • Olam Lang Women Initiative (OLLWI)
  • ONG Femmes-Santé-Développement
  • Organization of African Youth (OAYouth)
  • PAI
  • Pan American Health Organization
  • Pathfinder International
  • Philippine Business for Social Progress, Inc.
  • Planetary Health Alliance
  • Population Association of America
  • Population Council
  • Population Economics Research
  • Reach A Hand Uganda
  • The Regents of the University of California, Berkeley Campus
  • Research Council of Norway
  • Réseau des Journalistes pour la Santé Sexuelle et Reproductive (RJSSR)
  • SERAC-Bangladesh
  • Society of Gynaecology and Obstetrics of Nigeria (SOGON)
  • Solidarité avec les victimes et pour la paix (SOVIP)
  • The Medical Concierge Group (TMCG)
  • Today’s Women International Network (TWIN)
  • Tulane University
  • University of Colorado Boulder
  • University of North Carolina at Chapel Hill
  • University of Wisconsin-Madison
  • Women’s Action Group Zimbabwe
  • The Wilson Center
  • Worldwatch Institute
  • Youth Advocacy Network (YAN)
  • Youth Alliance for Reproductive Health-DRC (YARH-DRC)
  • YUWA
  • Zambian Statistical Agency

Through their generous contributions, the individuals listed here allowed PRB to fund essential program expansion and organizational innovations during the fiscal year ending Sept. 30, 2021.

  • George Ainslie
  • Amazon Smile Foundation
  • Michelle Behr
  • The Benevity Community Impact Fund
  • Brian Blouet
  • Thomas J. Brown
  • William P. Butz
  • Dan Carrigan
  • James R. Carter
  • Julie A. Caswell
  • Maxine E. Cordell-Brunton
  • George Daily
  • Philip Darney
  • William A. DeGrazia
  • Mary B. Deming
  • Carol DeVita
  • Marriner Eccles
  • Ecotrust
  • Eldon Enger
  • Laurence L. Falk
  • Kathryn A. Foster
  • Maricela Garcia Serrano
  • Linda W. Gordon
  • Richard Grossman
  • Edward Guay
  • Kenneth Haddock
  • Brice Harris
  • Philip Harvey
  • Daniel Hebding
  • Karen Santa Holl
  • Edwin W. and Janet G. House
  • Sherry F. Huber
  • Henry Imus
  • Eleanor Iselin
  • Jeffrey Neil Jordan
  • Joan R. Kahn
  • Robert B. Kelman
  • Mary M. Kritz
  • William Kurtz
  • Willie B. Lamouse-Smith
  • William Z. Lidicker
  • Gene Likens
  • Terri Ann Lowenthal
  • Jennifer Madans
  • David Maddox
  • Elizabeth Maguire
  • D.J. Mellema
  • Walter Mertens
  • Eugene Mulligan
  • Graham L. Mytton
  • Charles B. Nam
  • Network for Good
  • Margaret Neuse
  • Laurel A. Panser
  • Carol Prorok
  • Lydia Pulsipher
  • Ricardo R. Rodriguiz
  • John and Libby Ross
  • James Rubenstein
  • Elizabeth K. Schoenecker
  • Arthur Siegel
  • David J. Smith
  • Jean Smyth
  • Dick Solomon
  • Bertram Strieb
  • Chris Tarp
  • James W. Thompson
  • J.W. Valentine
  • Pietronella Van Den Oever
  • Edward V. Waller
  • Bonnie and Dirk Walters
  • John R. Weeks
  • Jesse Wells
  • Paul Wright
  • Gooloo S. Wunderlich
  • Clarence J. Wurdock


Fiscal year ending Sept. 30, 2021

2021 PRB Financials


Anxiety and Depression Increase Among U.S. Youth, 2022 KIDS COUNTS Data Book Shows

Children in the United States are experiencing a mental health crisis.

In 2020, 12% of U.S. children ages 3 to 17 were reported as having ever experienced anxiety or depression, up from 9% in 2016. This finding is among the key results from the 33rd edition of the Annie E. Casey Foundation’s KIDS COUNT Data Book, an annual assessment of how children are faring in the United States and in each state.

Drawing on data from the National Survey of Children’s Health, the 2022 Data Book shows that children in the United States are experiencing a mental health crisis, with rates of anxiety and depression at unprecedented levels. The 2022 Data Book also describes the connections between mental health and four dimensions of child well-being, and it provides recommendations for addressing the ongoing mental health crisis among youth, including:

  • Prioritize meeting kids’ basic needs.
  • Ensure every child has access to the mental health care they need, when and where they need it.
  • Bolster mental health care that takes into account young people’s experiences and identities.

Members of PRB’s U.S. Programs staff have played an essential role in the production of the Data Book since its inception, providing feedback on the design and measurement of the KIDS COUNT index and compiling the data presented in the report.

The Data Book provides information about child well-being in the period prior to and during the coronavirus pandemic. Ten out of the 16 key indicators showed improvement, with improvements in all four indicators of economic well-being and three of four indicators of family and community well-being. Four indicators worsened. Three of these four indicators are in the health domain, showing significant challenges for children’s physical health. In addition to rising levels of anxiety and depression, the child and teen death rate increased to 28 deaths per 100,000 people ages 1 to 19—the highest rates seen since 2008. This increase reflects a rise in homicides and drug overdoses among children and adolescents. The 2022 Data Book also highlights persistent racial and ethnicity disparities and shows that children of color continue to face steep barriers to success.

The annual assessment of child well-being in the 2022 Data Book is based on the most recent data available (2020 data for most indicators) and documents key trends since 2010. The COVID-19 pandemic disrupted reliable data collection for many key indicators. As a result, eight of the 16 indicators in the 2022 Data Book and KIDS COUNT index were compiled using data from the U.S. Census Bureau’s American Community Survey five-year estimates instead of their traditional source of one-year estimates. Data for three of the key education indicators could not be updated due to delays in data collection.

The 2022 KIDS COUNT Data Book may be accessed at Additional tools, maps, graphs, and data on many more indicators of child well-being are available at the KIDS COUNT Data Center.  


Information and Advice on 2020 Federal Data Quality and Use

How has the COVID-19 pandemic disrupted data collection and what are the ramifications for data quality?

While the COVID-19 pandemic has disrupted daily routines, schooling, work, health, and the economy around the world, it has also significantly impacted U.S. data collection for annual federal surveys and the release of statistics on the well-being of children and families. The disruptions in data collection limit our understanding of how the pandemic impacted families in 2020 and will have ramifications for data quality and availability for the next several years.

All major federal surveys implemented methodological changes in response to the COVID-19 pandemic. However, federal agencies faced different challenges and choices based on how their surveys were originally designed. Some agencies continued data collection efforts by shifting from in-person to phone or online interviewing modes while others suspended operations or delayed or extended data collection periods. New surveys, such as the Household Pulse Survey, were also developed to provide up-to-date information about how the pandemic was affecting the U.S. population, families, and children.

This brief summarizes changes to several U.S. Census Bureau surveys and programs that provide data on children and families—the American Community Survey (ACS), Current Population Survey (CPS), 2020 Census, and Population Estimates—as well as how to access data, evaluate data quality and usability, and what to do if the data you typically rely on are not available. A short outline of these changes, as well as information about many additional data sources, is available in a companion table, The COVID-19 Pandemic’s Impact on Federal Statistical Systems Data Collection and Data Quality.

Key Takeaways and Recommendations

American Community Survey (ACS)

  • The Census Bureau did not release the standard 2020 ACS 1-year data products. Instead, it produced experimental estimates.
  • The 2020 ACS 1-year experimental data release included selected tabulated data for the United States, the 50 states and the District of Columbia, and a 1-year Public Use Microdata Sample (PUMS) data set with the experimental weights.
  • The 2020 ACS 1-year experimental data should not be compared to any other ACS data or decennial census data.
  • Estimates for Public Use Microdata Areas (PUMAs), which can combine or split counties, should be used with caution as the experimental weights are not optimized to produce estimates for these areas.
  • The 2016-2020 ACS 5-year data were released under a waiver process because they did not meet the Census Bureau’s quality standards.
  • ACS 5-year data users need to pay close attention to the margins of error, which may be substantially larger than usual for all data releases that include the 2020 data (that is, the 2016-2020 through the 2020-2024 data release).
  • Data users who require a 1-year estimate should use 2019 data.
  • Data users who require a 5-year estimate can use 2016-2020 data. These data can be compared to prior non-overlapping 5-year data (that is, 2011-2015).

 Current Population Survey

  • Data users should use caution when comparing results from the 2020 Annual Social and Economic Survey (ASEC) with prior years and can refer to the 2020 ASEC documentation for more information.

2020 Census

Redistricting data file (P.L.-94) recommendations include:

  • Data users should consider aggregating small geographic areas to larger geographic areas with population sizes of 500 or more (for example, combine multiple census block groups together).
  • Data users should not divide data across tables (for example, do not divide the population by the number of housing units to obtain the average household size).
  • Data users may subtract data across tables (for example, subtract adult population from the total population to obtain a count of children).
  • 2020 Census results can generally be compared to prior censuses and ACS data.

Demographic and Housing Characteristics Tables

  • Those who are looking for data that have not yet been released (for example, data for 5-year age groups by sex and race) can first look to the Population Estimates Program to see if the desired data are available in the population estimates.
  • If the geographic area or characteristics are not available in Population Estimates, then data users can use the 2016-2020 ACS 5-year data. Please note that these data are period estimates covering 2016-2020 and data users should pay close attention to the margins of error.

U.S. Population Estimates

  • Vintage 2021 population estimates were produced using a blended base that incorporates data from multiple sources.
  • Data users should pay attention to trends over time in case the Vintage 2021 estimates are substantially higher or lower than the 2020 Census data or Vintage 2020 estimates.

Read the full report

Frequently Asked Questions

Where can I find estimates of poverty rates, income, and other measures of economic well-being for 2020?

  • For state-level estimates, use the 2021 CPS ASEC estimates. These data should provide reliable estimates at the state-level for large populations (all people, all children, etc.). Note that the poverty estimates from the CPS ASEC are not the same as from the ACS because of differences in how information about income is collected. PRB wrote an article summarizing the key differences between CPS ASEC estimates and ACS data.
  • Economic data are included in the 2020 ACS 1-year experimental estimates, though data users will likely need to use the PUMS data file to develop estimates. These data cannot be compared to prior years, so they are not useful for understanding trends in poverty rates and other measures of economic well-being.
  • The 2016-2020 ACS 5-year estimates are available for small geographic areas and can be used to disaggregate data by race and ethnicity. These data can be used for trend analyses when compared to another non-overlapping 5-year period and are available in tables on and through the PUMS data file.
  • The 2019 ACS 1-year estimates can continue to be used.
  • Small Area Income and Poverty Estimates (SAIPE) for 2020 are available. The U.S. Census Bureau did not provide updated methodological information, so the 2020 ACS data were likely incorporated into the model as usual.
  • The Household Pulse Survey provides data on economic well-being during the COVID-19 pandemic. These data should be used with caution as they are experimental and do not have a pre-pandemic benchmark.

Where can I find estimates of health insurance coverage for 2020?

  • For state-level estimates, use the 2021 CPS ASEC estimates. Note that health insurance estimates from the CPS ASEC are not comparable to those from the ACS. See a summary of differences between CSP ASEC estimates and ACS data by PRB for more information.
  • Health insurance estimates are included in the 2020 ACS 1-year experimental estimates, though data users will likely need to use the PUMS data file to develop estimates. These data cannot be compared to prior years, so they are not useful for understanding trends.
  • The 2016-2020 ACS 5-year estimates are available for small geographic areas and can be used to disaggregate data by race and ethnicity. These data can be used for trend analyses when compared to another non-overlapping 5-year period and are available in tables on and through the PUMS data file.
  • The 2019 ACS 1-year estimates can continue to be used.
  • Small Area Health Insurance Estimates (SAHIE) are planned to be released in summer 2022.
  • The State Health Access Data Assistance Center (SHADAC) produced state-level estimates for 2020 using the CPS ASEC data.

Where can I find 2020 birth data?

  • The pandemic did not impact the collection of birth data. Use usual sources and methods, such as your state Department of Health office, National Center for Health Statistics reports, and CDC Wonder.

Where can I find 2020 mortality data?

  • The pandemic did not impact the collection of mortality data. Use usual sources and methods, such as your state Department of Health office, National Center for Health Statistics reports, and CDC Wonder.

Where can I find additional child health data?

  • One option is to use data from the National Survey of Children’s Health (NSCH). For state-level estimates, data users should pool two to three years of data together.
  • The COVID-19 pandemic had no impact on response rates or data quality for the 2020 data.

Where can I access education-related statistics in 2020?

  • For updating trends, data users will need to determine if the original data provider made any changes in 2020.
    • For state-provided administrative data or state test scores obtained through states’ Departments of Education, data users will need to find out how the state handled attendance records, state-testing, etc., when schools were closed, in remote-only learning modes, and hybrid-learning modes.
    • For data submitted to the federal government and released through the National Center of Education Statistics (NCES): NCES has not announced what data will be available or any concerns about data quality; however, some 2019-2020 school-year data are delayed relative to prior year release dates.
    • For achievement data through National Assessment for Educational Progress (NAEP): The 2021 assessments were delayed until 2022. New data are expected in late 2022.
  • The Household Pulse Survey included some questions about the delivery and receipt of education over the course of the pandemic. Data users should be aware that these data are experimental and that the Household Pulse Survey has a very low response rate (less than 5%). The questions also changed and have not been asked in all phases of the survey.
  • Data from the ACS and the CPS can also be used for school enrollment and educational attainment data.
Frustrated student

More Sleep Could Improve Many U.S. Teenagers’ Mental Health

California now requires most high schools to start no earlier than 8:30 a.m. to support students’ well-being and safety.

Most American teenagers are sleep deprived: Fewer than one in four U.S. high school students gets the recommended eight hours of sleep per night.1

Researchers who study the relationship between sleep and depression are unanimous: Adequate sleep could greatly improve many U.S. teenagers’ mental health.

“Perpetually fatigued adolescents look and feel depressed,” says Rachel Widome of the University of Minnesota. Her research links adequate sleep to fewer symptoms of depression among teenagers.2

“Poor sleep and depression are reinforcing—depression interferes with sleep, and not enough sleep leaves someone feeling like they don’t have energy to engage in life, which is a symptom of depression.”

The notion that anyone “can push through on little sleep with little cost to mental health is a myth,” says Andrew Fuligni of the University California, Los Angeles. His research demonstrates that despite some individual variation, most teenagers need about 8.5 hours of sleep to function at their best.3

“Mental health is very sensitive to sleep,” he explains. “To operate at peak levels—emotionally and intellectually—most teens should sleep between eight and 10 hours each night. Less than seven and more than 11 hours is unhealthy.”

Mounting Evidence Shows Later High Schools Start Times Are Key to Better Sleep

Telling teenagers to go to bed earlier is not the answer. The entire circadian-driven sleep cycle—both sleep and wake times—is temporarily pushed later in adolescence because of hormonal changes, Fuligni explains. Child health advocates have been calling for later school start times since the 1980s and 1990s, he notes.

Growing scientific evidence on the benefits of later school start times is behind a new California law, which goes into effect July 1, 2022, that will bar most high schools from starting classes before 8:30 a.m.

The key findings spurring school districts to consider later school start times come from Widome and colleagues, who tracked students at five public Minnesota high schools using wrist monitors (actigraphy) that accurately measured the students’ sleep.4 They showed that when schools instituted later start times, students slept longer and their need for catch-up sleep on the weekends shrank. Students’ bedtimes did not move with the later start time, and they continued to get better sleep over two years.

Additional evidence comes from analysis of a multi-year study conducted by Kayla Wahlstrom and colleagues at the University of Minnesota.5 They examined data on more than 9,000 students attending eight high schools in three states that switched to later start times and documented improved sleep. When schools started after 8:30 a.m., attendance, standardized test scores, and academic performance in math, English, science, and social studies increased, while tardiness declined. One school that shifted start times from 7:35 a.m. to 8:55 a.m. saw a 70% decline in the number of local car accidents among drivers ages 16 to 18.

Despite the documented benefits of later school start times, only about 15% of U.S. high schools start at 8:30 a.m. or later, while 42% start before 8:00 a.m., Widome reports. “Early high school start times are strictly a United States phenomenon,” she notes. “Europe and Australia do not start school so early.”

Some parents and school officials have voiced opposition to changing school start times because the current timing facilitates after-school sports and allows the same school buses to transport high schoolers early in the morning and young children afterward. Family schedules are also often built around early start times that enable “the older kids to get home first to watch the younger ones,” she says.

“It’s appalling that our nation is willing to accept that teens are extremely fatigued during their adolescent years,” says Widome, “when there is a straightforward evidence-based solution—starting school later.”

Teenagers’ Mental Health Problems Rose as Adequate Sleep Declined

The mental health crisis among American youth began growing long before the coronavirus pandemic: In 2019, more than one in three high school students reported “persistent feelings of sadness or hopelessness,” representing a 40% increase from 2009, according to the U.S. Centers for Disease Control and Prevention (CDC).6

During that same period, teenagers’ nightly sleep dropped sharply: The share of high school students getting the recommended minimum of eight hours of sleep declined from nearly 31% in 2009 to around 22% in 2019.7

Research shows a strong connection between sleep and symptoms of depression. In a 2019 study, Widome and colleagues showed that about one in three students who slept less than six hours per night had a high number of depression symptoms compared with about one in 10 students who got adequate sleep.8 But inadequate sleep is one of many factors affecting teenagers’ mental health.

The rise in sleep-deprived teenagers is a long-term trend, reports Widome. “A lot in our society has changed in the last decade, including more time spent using screens—phones, games, computers—and marketing caffeine drinks to adolescents.” In her 2019 study, teenagers who had inadequate sleep tended to spend twice as much time on devices with screens than their peers and were more likely to use those devices after they went to bed.

“We know people feel better when they get enough sleep,” notes Widome. “If we improved sleep, how much of that is addressing the tiredness that looks like depression? It is easy to forget how critically important sleep is to our lives.”

What Biology Tells Us About the Connections Among Sleep, Stress, Depression, and Disease

One way that poor sleep appears to heighten the risk of depression is by activating the body’s stress response system. Fuligni and colleagues identified altered levels of cortisol—the stress hormone—in the saliva of teenagers with consistently inadequate sleep.9 In a related study, the researchers showed that inadequate sleep exacerbated the connection between daily stress and inflammation-triggering genes, another biological sign of stress.10

Poor sleep can keep the body’s stress response system on high alert long term, which can have a profound impact on many of the body’s systems—not just increasing the risk of depression but laying a foundation for chronic conditions such as heart disease later in life, according to Fuligni.

The researchers found that students in 10th and 11th graes who consistently reported inadequate sleep were more vulnerable to depression several years later.11 Interventions designed to improve sleep during the high-school years may prevent depression among young people in their early 20s, when an individual’s risk of depression is highest, the researchers suggest.

Additional Strategies for Improving Teenagers’ Sleep

Starting high schools later in the morning is the number one way to improve teenagers’ sleep, both Fuligni and Widome say. They express concerns over legislation to make Daylight Saving Time permanent because more high school students would go to school in the dark and wouldn’t see the sun rise until after their first period classes.

Widome favors permanent Standard Time, which would set sunrise earlier—helpful to teenagers’ waking—despite earlier evening sunsets. Both Fuligni and Widome agree that the current switch from Daylight Saving Time that moves clocks ahead in spring is a challenging adjustment for teenagers.

Along with later school start times, Fuligni would like to see school administrators and teachers assess whether students are sacrificing sleep for homework and adjust their expectations. If Widome were making school policy, she also would eliminate online assignments that have midnight due dates and ban high school clubs from meeting before 8:00 a.m.

“We need to really value sleep,” she says, “not see it as something extraneous that is only for the weak.”

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of Minnesota (5P2CHD041023-19) and University of California, Los Angeles (5P2CHD041022-19).


[1] Centers for Disease Control and Prevention (CDC), High School Students Who Got 8 or More Hours of Sleep, YRBS Explorer.

[2] Aaron T.  Berger, Kyla L. Wahlstrom, Rachel Widome, “Relationships Between Sleep Duration and Adolescent Depression: A Conceptual Replication,” Sleep Health 5, no. 2 (2019): 175-9, doi:10.1016/j.sleh.2018.12.003.

[3] Andrew J. Fuligni et al., “Individual Differences in Optimum Sleep for Daily Mood During Adolescence,” Journal of Clinical Child and Adolescent Psychology 48, no. 3 (2019): 469-79.

[4] Rachel Widome et al., “Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents,” JAMA Pediatrics 174, no. 7 (2020): 697-704, doi:10.1001/jamapediatrics.2020.0344.

[5] Kayla L. Wahlstrom et al, Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study (Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN: 2014).

[6] CDC, “Adolescent and School Health: Mental Health,” n.d.

[7] CDC, High School Students Who Got 8 or More Hours of Sleep.

[8] Rachel Widome et al., “Correlates of Short Sleep Duration Among Adolescents,” Journal of Adolescence 77 (2019): 163-7.

[9] Kate Ryan Kuhlman et al., “Sleep Problems in Adolescence Are Prospectively Linked to Later Depressive Symptoms Via the Cortisol Awakening Response,” Developmental Psychopathology 32, no. 3 (2020): 997-1006.

[10] Jessica J. Chiang et al., “Daily Interpersonal Stress, Sleep Duration, and Gene Regulation During Late Adolescence,” Psychoneuroendocrinology 103 (2019): 147-55, doi: 10.1016/j.psyneuen.2018.11.026.

[11] Kate Ryan Kuhlman et al., “Persistent Low Positive Affect and Sleep Disturbance Across Adolescence Moderate Link Between Stress and Depressive Symptoms in Early Adulthood,” Journal of Abnormal Child Psychology 48, no. 1 (2020): 109-21, doi: 10.1007/s10802-019-00581-y.


Abortion: A Global Overview

Abortion's legal status does not significantly affect the rate at which the procedure occurs but does affect the conditions under which it occurs. Unsafe abortions claim the lives of tens of thousands of women around the world every year.

Abortion is a public health concern. It is also a sensitive and contentious issue with religious, moral, cultural, and political dimensions.


More than one-quarter of the world’s people live in countries where the procedure is prohibited or permitted only in cases of rape, incest, or fetal abnormalities, or to save the pregnant person’s life. Yet, regardless of legal status, abortions still occur, and nearly half of them are unsafe—performed by unskilled practitioners or in less than hygienic conditions, or both.

Abortions performed under unsafe conditions claim the lives of tens of thousands of women around the world every year, leave many times that number with chronic and often irreversible physical and mental health problems, and drain the resources of public health systems. Controversy, however, often overshadows the public health impact.1

An estimated 73 million abortions occur globally each year.

Nearly half of them—45%—are unsafe.2

Globally, unsafe abortion accounts for up to 13% of deaths related to pregnancy and childbirth.3

Abortions are considered unsafe when they are performed by people who lack the necessary skills and information or in an environment that doesn’t meet minimum medical standards, or both.4

Worldwide, at least 7 million women are treated for complications from unsafe abortion each year.5

When abortion is performed by qualified people using correct techniques in hygienic conditions, it is very safe. In the United States—where abortion has been legal since 1973, with restrictions that vary by state—the death rate from induced abortion is less than one per 100,000 procedures.6

Unsafe abortions occur more often where abortion is restricted by law.7

The legal status of abortion is one factor that determines the extent to which the procedure is safe, affordable, and accessible.8


In countries that…
Allow abortion for any reason, nearly 90% of abortions are safe.
Have broad restrictions, about 41% of abortions are safe.
Prohibit abortion or allow it only to save the life of the woman or protect her physical health, only 25% of abortions are safe.

Source: Bela Ganatra et al., “Global, Regional, and Subregional Classification of Abortions by Safety, 2010-14: Estimates From a Bayesian Hierarchical Model,” The Lancet 390, no. 10110 (2017).


While abortion is more common in some countries than others, it occurs in every country. Where the procedure is broadly legal, abortions are more likely to be performed by trained health professionals, be more available, and cost less—and maternal deaths and injuries tend to be lower.9

In the United States, banning abortion could raise pregnancy-related death rates.10

A nationwide ban on abortion in the United States would lead to an estimated 21% increase in the number of pregnancy-related deaths for all women and a 33% increase among Black women compared with rates for 2017, as calculated by Amanda Stevenson of the CU Population Center at the University of Colorado Boulder.11 These estimates consider only increased deaths from a ban due to pregnancy complications and delivery—both of which are more risky than abortion; they do not include increases due to unsafe abortion.


Increased Lifetime Risk of Pregnancy-Related Death Following a U.S. Ban on Abortion

Lifetime Risk (2017) Estimated Increased Risk
White women 1 in 4,500 1 in 3,900
Black women 1 in 1,300 1 in 1,000

Source: Amanda Jean Stevenson, “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant,” Demography (2021).

Abortion’s legal status does not significantly affect the rate at which the procedure occurs.


Countries that prohibit abortion for any reason 39 abortions per 1,000 women
Countries that allow abortion only to save the woman’s life 36 abortions per 1,000 women
Countries that permit abortion without restriction 41 abortions per 1,000 women

Source: Guttmacher Institute, “Unintended Pregnancy and Abortion Worldwide” (2022).

For More Information

These PRB resources provide context on the state of abortion worldwide and identify links between access to safe abortion and maternal health outcomes.


[1] PRB, Abortion Facts and Figures 2021 (Washington, DC: PRB, 2021).

[2] World Health Organization (WHO), “Abortion,” Nov. 25, 2021.

[3] WHO, “Preventing Unsafe Abortion” (2019).

[4] WHO, “Preventing Unsafe Abortion.

[5] WHO, “Abortion.”

[6] Katherine Korsmit et al., “Abortion Surveillance—United States, 2019,” Surveillance Summaries 70, no. 93 (2021): 1-29.

[7] Bela Ganatra et al., “Global, Regional, and Subregional Classification of Abortions by Safety, 2010-14: Estimates From a Bayesian Hierarchical Model,” The Lancet 390, no. 10110 (2017).

[8] WHO, “Abortion.”

[9] Susheela Singh et al., Abortion Worldwide 2017: Uneven Progress and Unequal Access (New York: Guttmacher Institute, 2018).

[10] PRB, “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds,” Dec. 6, 2021.

[11] Amanda Jean Stevenson, “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant,” Demography (2021).