Projected US demographic shifts require fresh look at care delivery and resources

The Buzz This Week

The United States will be facing significant demographic shifts in the coming years. Planning for these trends is critical to advance organizational sustainability and health equity.

US Census projections indicate a decline in population growth in the coming decades. Estimates show the total population peaking at nearly 370 million in 2080 before gradually dropping to 366 million in 2100. These projections, outlined in a recent report, attribute this decline to factors such as lower fertility and birth rates and higher death rates.

The decline in fertility rates (the number of births per woman across her lifetime) has persisted for decades. Although rates increased slightly in 2021 (for the first time since 2014), rates are still trending downward overall.

Death rates have been increasing for years, led by the aging of the US population and punctuated by events such as the pandemic. A recent uptick in mortality among younger Americans has also impacted mortality rates. Evidence points to higher deadly disease prevalence (e.g., cardiometabolic diseases), as well as an increase in drug overdoses, alcohol-related deaths, and suicides. Already high maternal mortality rates are rising, as are infant mortality rates.

Baby boomer aging also will accelerate the shift in age distribution. Census projections indicate that by 2030, the population in older age groups will surpass that of younger age groups. 29.1% are projected to be aged 65 or older, compared to 16.4% under age 18.

In addition to changes in age distribution, the Census projects a shift in racial group distribution over the next few decades. The percentage of non-Hispanic whites will fall as low as 43% in 2060, down from 59% in 2022. Meanwhile, the Hispanic population may reach as high as 28% in 2060, up from 19% in 2022.

Alongside these demographic shifts, health disparities persist in life expectancy, disease burden, insurance coverage, access to care, and mortality rates. For example, the US’s alarmingly high preterm birth rates reveal significant racial and ethnic disparities. They notably affect Black mothers and infants more than white and Asian counterparts. The March of Dimes found 14.6% of Black infants were born preterm, while only 9.4% of white infants and 9% of Asian infants faced similar outcomes. Stark disparities also exist in infant mortality, with rates among Black and American Indian/Alaskan Native infants 2.3 times higher than among white and Hispanic infants.

Why It Matters

These population trends will have implications for healthcare delivery and resources, including:

The growing cohort of older Americans will require greater long-term care capacity and support services. This includes more chronic disease management services and care navigation assistance. Efforts to support healthy aging will also be important.
Addressing disparities in maternal and infant health will be an imperative for delivery systems, insurers, and policymakers. Drivers behind maternal and infant mortality rates have been studied for years. But most efforts to improve the abysmal rates in the US have not been effective.
Tailored care and services will be a key part of reducing health disparities. This could include enhanced translation services, more extensive patient education, and efforts to boost the diversity of the physician population. Studies have shown minority populations have better outcomes when treated by minority physicians.
Additional studies will be needed to understand growing mortality rates among younger people. Findings might suggest earlier disease screenings as part of preventive/primary care and investment in developing new treatments specific to younger people.
New sources of funding and programs will be essential to better serve changing population needs. Such efforts can ameliorate health disparities and optimize the health of the entire population. Legislators will need to take a lead in pushing forward many of these efforts.
Another reexamination of the US health insurance system is likely needed. The Medicare Trust Fund stands on precarious ground as tax contributions from younger age cohorts can’t keep up with those of retirees leaving the workforce.

Understanding the demographic trends and shifts in the US is important. But actively adjusting healthcare delivery, policy, and payment systems will be the only way to create a more sustainable healthcare system that cultivates better health for all.