Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of white and black Americans.

Longitudinal data from a 15-year national survey of adults are used to test the double jeopardy to health hypothesis as well as the alternative hypotheses that aging levels ethnic differences and that health inequalities persist across the life course. Findings show that African Americans began the study in poorer health and manifested higher mortality. Among survivors, young and middle-aged Black adults developed more serious illness and their subjective health declined more rapidly than their Whites counterparts during the first 10 years of the study. Among subjects with heart failure, Black people were also more likely than Whites to become more disabled over time. Depending upon the health measure considered and the analytic strategy applied, there was evidence for all three processes, but the weight of the evidence shows persistent health inequality over the life course. Indeed, evidence for the age-as-leveler thesis was eliminated by accounting for mortality during the study.