Health-related quality of life in older adults: Testing the double jeopardy hypothesis

The double jeopardy hypothesis posits that racial minority elderly suffer a double disadvantage to health due to the interactive effects of age and race. Empirical examinations have found mixed support for the proposition that the aging process heightens the health disadvantage for racial minorities compared to whites. Race-by-age differences are tested using a health-related quality of life measure that has been largely overlooked in previous double jeopardy analyses. The outcome, number of days in poor physical health during the past month, quantifies day-to-day physical well-being in a way not available to standard measures of morbidity and mortality. The data are from the 2003 California Health Interview Survey (CHIS) and were analyzed using negative binomial regression. Results show that the magnitude of differences in the number of physically unhealthy days for African Americans and Hispanics compared to their white counterparts is much larger in the elderly strata than that observed between younger groups. Additionally, social characteristics do not fully explain why racial differences in poor physical health days are greater at older ages. A life course perspective is proposed as one possible explanation for the double jeopardy finding. The results indicate a need to consider health-related quality of life outcomes when examining racial/ethnic health disparities among the elderly population. The appendix presents cross-validation of the 2003 CHIS results with the 2005 CHIS and the findings are replicated.