This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.
AilshireJennifer A.HouseJames S.2011. “The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002.” Social Forces90(2):397–423.
2.
AlonS.2007. “Overlapping Disadvantages and the Racial/Ethnic Graduation Gap among Students Attending Selective Institutions.” Social Science Research36(4):1475–99.
3.
AndersonRoger T.JamesMargaret K.MillerMichael E.WorleyAngela S.LonginoCharles F.Jr.1998. “The Timing of Change: Patterns in Transitions in Functional Status among Elderly Persons.” Journal of Gerontology: Social Sciences53B(1): S17–S27.
4.
BeckAllen J.KarbergJennifer C.2001. Prison and Jail Inmates at Midyear 2000. Bureau of Justice Statistics Bulletin. NCJ 185989. Washington, DC: U.S. Department of Justice.
5.
BealFrances M.1970. Double Jeopardy: To Be Black and Female. Detroit, MI: Radical Education Project.
6.
BirdChloeRiekerPatricia. 2008. Gender and Health: The Effects of Constrained Choices and Social Policies. New York: Cambridge University Press.
7.
BradyDavid. 2009. Rich Democracies, Poor People: How Politics Explain Poverty. New York: Oxford University Press.
8.
BratterJeniferGormanBridget. 2011. “Is Discrimination an Equal Opportunity Risk? Racial Experiences, Socioeconomic Status and Health Status among Black and White Adults.” Journal of Health and Social Behavior52(3):365–82.
9.
BravemanPaula A.CubbinCatherineEgerterSusanChideyaSekaiMarchiKristen S.MetzlerMarilynPosnerSamuel. 2005. “Socioeconomic Status in Health Research: One Size Does Not Fit All.” Journal of the American Medical Association294(22):2879–88.
10.
BrownTyson H.HargroveTaylor W.2013. “Multidimensional Approaches to Examining Gender and Racial/Ethnic Stratification in Health.” Women, Gender, and Families of Color1(2):180–206.
11.
BrownTyson H.O’RandAngelaAdkinsDaniel E.2012. “Race/Ethnicity and Health Trajectories: Tests of Three Hypotheses across Multiple Groups and Health Outcomes.” Journal of Health and Social Behavior53(3):359–77.
12.
ChooHae YeonFerreeMyra Marx. 2010. “Practicing Intersectionality in Sociological Research: A Critical Analysis of Inclusions, Interactions and Institutions in the Study of Inequalities.” Sociological Theory28(2):147–67.
13.
ClarkDaniel O.MaddoxGeorge L.1992. “Racial and Social Correlates of Age-related Changes in Functioning.” Journal of Gerontology: Social Sciences47(5):S222–S232.
14.
ColenCynthia G.2011. “Addressing Racial Disparities in Health Using Life Course Perspectives: Toward a Constructive Criticism.” Du Bois Review8(1):79–94.
15.
CollinsPatricia H.2000. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Routledge.
16.
CourtenayWill H. 2000. “Constructions of Masculinity and Their Influence on Men’s Well Being: A Theory of Gender and Health.” Social Science & Medicine50(10):1385–1401.
17.
CummingsJason L.JacksonPamela Braboy. 2008. “Race, Gender, and SES Disparities in Self-assessed Health, 1974–2004.” Research on Aging30(2):137–67.
18.
DanneferDale. 2003. “Cumulative Advantage/Disadvan-tage and the Life Course: Cross Fertilizing Age and Social Science Theory.” Journals of Gerontology. Series B58(6):S327–S337.
19.
DavisAngela. 1981. Women, Race, and Class. New York: Random House.
20.
DillBonnie T.ZambranaRuth E.2009. “Critical Thinking about Inequality: An Emerging Lens.” Pp. 1–21 in Emerging Intersections: Race, Class, and Gender in Theory, Policy, and Practice, edited by DillB. T.ZambranaR. E.Piscataway, NJ: Rutgers University Press.
21.
Du BoisW. E. B. 1899. The Philadelphia Negro: A Social Study. Philadelphia: University of Pennsylvania.
22.
DupreMatthew. 2007. “Educational Differences in Age-related Patterns of Disease: Reconsidering the Cumulative Disadvantage and Age-as-leveler Hypotheses.” Journal of Health and Social Behavior48(1):1–15.
23.
ElderGlen H.JohnsonMonica K.CrosnoeRobert. 2003. “Emergence and Development of Life Course Theory.” Pp. 3–22 in Handbook of the Life Course, edited by MortimerJ. T.ShanahanM. J.New York: Kluwer.
24.
FarmerMelissaFerraroKenneth F.2005. “Are Racial Disparities in Health Conditional on Socioeconomic Status?”Social Science & Medicine60(1):191–204.
25.
FerraroKenneth F.FarmerMelissa M.1996. “Double Jeopardy to Health Hypothesis for African Americans: Analysis and Critique.” Journal of Health and Social Behavior37(1):27–43.
26.
FerraroKenneth F.FarmerMelissa M.WybraniecJohn A.1997. “Health Trajectories: Long-term Dynamics among Black and White Adults.” Journal of Health and Social Behavior38(1):38–54.
27.
FerraroKenneth F.ShippeeTetyana PylypivSchaferMarkus H.2009. “A Theory of Age and the Accumulation of Inequality.” Pp. 413–433 in Handbook of Theories of Aging, edited by BengtsonV. L.SilversteinM.PutneyN.M.GansD.2nd ed.New York: Springer.
28.
FewApril L. 2007. “Integrating Black Consciousness and Critical Race Feminism into Family Studies Research. Journal of Family Issues28(4):452–73.
29.
GeeGilbert C.FordChandra L.2011. “Structural Racism and Health Inequities: Old Issues, New Directions.” Du Bois Review: Social Science Research on Race8(1):115–32.
30.
GeronimusArline T.KeeneDanyaHickenMargaretBoundJohn. 2007. “Black–White Differences in Age Trajectories of Hypertension Prevalence among Adult Women and Men, 1999–2002.” Ethnicity and Disease17(1):40–48.
31.
GoosbyBridget J.HeidebrinkChelsea. 2013. “The Transgenerational Consequences of Racial Discrimination on African-American Health Outcomes.” Sociology Compass7(8):630–43.
32.
GreenmanEmilyXieYu. 2008. “Double Jeopardy? The Interaction of Gender and Race on Earnings in the United States.” Social Forces86(3):1–28.
33.
GriffithDerek M.EllisKatrina R.AllenJulie O.2013. “An Intersectional Approach to Social Determinants of Stress for African American Men: Men’s and Women’s Perspectives.” American Journal of Men’s Health7(4S):16–27.
34.
GrollmanEric A.2014. “Multiple Disadvantaged Statuses and Health: The Roles of Multiple Forms of Discrimination.” Journal of Health and Social Behavior55(1):3–19.
35.
HaasSteven A.RohlfsenLeah. 2010. “Life Course Determinants of Racial and Ethnic Disparities in Functional Health Trajectories.” Social Science & Medicine70(2):240–50.
36.
HarnoisCatherine E.IfatunjiMosi A.2011. “Gendered Measures, Gendered Models: Toward an Intersectional Analysis of Interpersonal Racial Discrimination.” Ethnic and Racial Studies34(6):1006–28.
37.
HaywardMark D.MilesToni P.CrimminsEileen M.YangYu. 2000. “The Significance of Socioeconomic Status in Explaining the Racial Gap in Chronic Health Conditions.” American Sociological Review65(6):910–30.
38.
HaywardMark D.WarnerDavid F.CrimminsEileen M.2007. “Does Longer Life Mean Better Health? Not for Native-born Mexican Americans in the Health and Retirement Survey.” Pp. 85–95 in The Health of Aging Hispanics: The Mexican-origin Population, edited by AngelJ. L.WhitfieldK. E.New York: Springer.
39.
HenrettaJohn C.CampbellRichard T.1976. “Status Attainment and Status Maintenance: A Study of Stratifcation in Old Age.” American Sociological Review41(6):981–92.
40.
HinzeSusan W.LinJieluAnderssonTanetta E.2012. “Can We Capture the Intersections? Older Black Women, Education, and Health.” Women’s Health Issues22(1):e91–e98.
41.
HouseJames S.LantzPaula M.HerdPamela. 2005. “Continuity and Change in the Social Stratification of Aging and Health over the Life Course: Evidence from a Nationally Representative Longitudinal Study from 1986 to 2001/2002 (Americans’ Changing Lives Study).” Journals of Gerontology: Series B60B(Special Issue 2):15–26.
42.
HummerRobert A.RogersRichard G.AmirSarit H.ForbesDouglasFrisbieW. Parker. 2000. “Adult Mortality Differentials among Hispanic Subgroups and Non-Hispanic Whites.” Social Science Quarterly81(1):459–76.
43.
IdlerEllen L.2003. “Discussion: Gender Differences in Self-rated Health, in Mortality, and in the Relationship between the Two.” Gerontologist43(3):372–75.
44.
IdlerEllen L.BenyaminiYael. 1997. “Self-rated Health and Mortality: A Review of Twenty-seven Community Studies.” Journal of Health and Social Behavior38(1):21–37.
45.
JacksonP. B.WilliamsDavid R.2006. “The Intersection of Race, Gender, and SES: Health Paradoxes.” Pp. 131–62 in Gender, Race, Class and Health: Intersectional Approaches, edited by ShulzA.MullingsL.San Francisco: Jossey-Bass.
46.
JeffriesVincentRansfordH. Edward. 1980. Social Stratification: A Multiple Hierarchy Approach. Boston: Allyn & Bacon.
47.
JohnsonRobert J.WolinksyFredric D.1994. “Gender, Race, and Health: The Structure of Health Status among Older Adults.” Gerontologist34(1):24–35.
48.
KimJinyoungMiechRichard. 2009. “The Black–White Difference in Age Trajectories of Functional Health over the Life Course.” Social Science & Medicine68(4):717–25.
49.
KimbroRachel TolbertGormanBridget K.SchachterAriela. 2012. “Acculturation and Self-rated Health among Latino and Asian Immigrants to the United States.” Social Problems59(3):341–63.
50.
KingDeborah K.1988. “Multiple Jeopardy, Multiple Consciousness: The Context of Black Feminist Ideology.” Signs14(1):42–72.
51.
LandryBart. 2007. Race, Gender, and Class: Theory and Methods of Analysis. Upper Saddle River, NJ: Pearson Prentice Hall.
52.
LantzPaula M.LynchJohn W.HouseJames S.LepkowskiJames M.MeroRichard P.MusickMarc A.WilliamsDavid R.2001. “Socioeconomic Disparities in Health Change in a Longitudinal Study of US Adults: The Role of Health-risk Behaviors.” Social Science & Medicine53(1):29–40.
53.
LaVeistThomasGaskinDarrell J.RichardPatrick. 2011. “Estimating the Economic Burden of Racial Health Inequalities in the United States.” International Journal of Health Services41(2):231–38.
54.
LaVeistThomasPollackKeishaThorpeRolandFesahazionRuthGaskinDarrell. 2011. “Place, Not Race: Disparities Dissipate in Southwest Baltimore When Blacks and Whites Live under Similar Conditions.” Health Affairs30(10):1880–87.
55.
LeeHedwigWildemanChris. 2013. “Things Fall Apart: Health Consequences of Mass Imprisonment for African American Women.” Review of Black Political Economy40(1):39–52.
56.
LiangJerseyBennettJoan M.ShawBenjamin A.QuiñonesAna R.YeWenXuXiaoOfstedalMary Beth. 2008. “Gender Differences in Functional Status in Middle and Older Age: Are There Any Age Variations.” Journal of Gerontology: Social Sciences63B(5):S282–S292.
57.
LinkBruce G.PhelanJo C.1995. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior35(Extra Issue):80–94.
58.
MarkidesKyriakos S.EschbachKarlRayLaura A.PeekM. Kristen. 2007. “Census Disability Rates among Older People by Race/Ethnicity and Type of Hispanic Origin.” Pp. 26–39 in The Health of Aging Hispanics: The Mexican-origin Population, edited by AngelJ. L.WhitfieldK. E.New York: Springer.
59.
MarkidesKyriakos S.RudkinLauraAngelRonald J.EspinoDavid V.1997. “Health Status of Hispanic Elderly.” Pp. 285–300 in Racial and Ethnic Differences in the Health of Older Americans, edited by MartinL. G.SoldoB. J.Washington, DC: National Academy Press.
60.
MarmotMichael G.SmithGeorge D.StansfeldStephenPatelChandraNorthFionaHeadJennyWhiteIanBrunnerEricFeeneyAmanda. 1991. “Health Inequalities among British Civil Servants: The Whitehall II Study.” Lancet37(8754):1387–93.
61.
MasseyDouglas S.2007. Categorically Unequal: The American Stratification System. New York: Russell Sage Foundation.
62.
McCallLeslie. 2005. “The Complexity of Intersectionality.” Signs30(3):1771–1800.
63.
Nuru-JeterAmaniDominguezTyan ParkerHammondWizdom PowellLeuJanxinSkaffMarilynEgerterSusanJonesCamara P.BravemanPaula. 2008. “‘It’s the Skin You’re In’: African-American Women Talk about Their Experiences of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies.” Maternal and Child Health Journal13(1):29–39.
64.
OliverMelvin L.ShapiroThomas M.2006. Black Wealth/White Wealth: A New Perspective on Racial Inequality. 10th anniversary ed. New York: Routledge.
65.
O’RandAngela M.HenrettaJohn C.1999. Age and Inequality: Diverse Pathways through Later Life. Boulder, CO: Westview Press.
66.
PattilloMary. 2005. “Black Middle-class Neighborhoods.” Annual Review of Sociology31:305–29.
67.
PavalkoEliza K.CaputoJennifer. 2013. “Social Inequality and Health across the Life Course.” American Behavioral Scientist57(8):1040–56.
68.
PearsonJay A.2008. “Can’t Buy Me Whiteness: New Lessons from the Titanic on Race, Ethnicity, and Health.” Du Bois Review5(1):27–48.
69.
PettitBecky. 2012. Invisible Men: Mass Incarceration and the Myth of Black Progress. New York: Russell Sage Foundation.
70.
PleisJohn R.WardBrian W.LucasJacqueline W.2010. “Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009.” Vital and Health Statistics10(242):1–207.
71.
RaudenbushStephen W.BrykAnthony S.2002. Hierarchical Linear Models: Applications and Data Analysis Methods. Thousand Oaks, CA: Sage.
72.
ReadJen’Nan G.GormanBridget K.2006. “Gender Inequalities in U.S. Adult Health: The Interplay of Race and Ethnicity.” Social Science & Medicine62(5):1045–65.
73.
ReadJen’Nan G.GormanBridget K.2010. “Gender and Health Inequality.” Annual Review of Sociology36:371–86.
74.
RileyMatilda W.JohnsonMarilyn E.FonerAnne1972. Age and Society: A Sociology of Age Stratification. New York: Russell Sage Foundation.
75.
RossCatherine E.WuChia-Ling. 1996. “Education, Age, and the Cumulative Advantage in Health.” Journal of Health and Social Behavior37(1):104–20.
76.
SchiemanScottPlickertGabriele. 2007. “Functional Limitations and Changes in Levels of Depression among Older Adults: A Multiple-hierarchy Stratification Perspective.” Journal of Gerontology, Social Sciences62B(1):S36–S42.
77.
SchulzAmy J.MullingsLeith. 2006. Gender, Race, Class, and Health: Intersectional Approaches. San Francisco: Jossey-Bass.
78.
ShetterlySusan M.BasterJudithMasonLynn D.HammanRichard F.1996. “Self-rated Health among Hispanic vs Non-Hispanic White Adults: The San Luis Valley Health and Aging Study.” American Journal of Public Health86(12):1798–1801.
79.
ShueyKim M.WillsonAndrea E.2008. “Cumulative Disadvantage and Black–White Disparities in Life-course Health Trajectories.” Research on Aging30(2):200–25.
80.
ThoitsPeggy A.2010. “Stress and Health: Major Findings and Policy Implications.” Journal of Health and Social Behavior51(S):S41–S53.
81.
TurnerJay R.AvisonWilliam R.2003. “Status Variations in Stress Exposure among Young Adults: Implications for the Interpretation of Prior Research.” Journal of Health and Social Behavior44(4):488–505.
82.
UmbersonDebraWilliamsKristiThomasPatricia A.LiuHuiThomeerMieke B.2014. “Race, Gender and Chains of Disadvantage: Childhood Adversity, Social Relationships, and Health.” Journal of Health and Social Behavior55(1):20–38.
83.
VeenstraGerry. 2013. “The Gendered Nature of Discriminatory Experiences by Race, Class, and Sexuality: A Comparison of Intersectionality Theory and the Subordinate Male Target Hypothesis.” Sex Roles68(11/12):646–59.
84.
VerbruggeLois M.1985. “Gender and Health: An Update on Hypotheses and Evidence.” Journal of Health and Social Behavior26(3):156–82.
85.
VincentGrayson K.VelkoffVictoria A.2010. The Next Four Decades, the Older Population in the United States: 2010 to 2050. Current Population Reports. P25-1138. Washington, DC: U.S. Census Bureau.
86.
WarnerDavid F.BrownTyson H.2011. “Under-standing How Race/Ethnicity and Gender Define Age-trajectories of Disability: An Intersectionality Approach.” Social Science & Medicine72(8):1236–48.
87.
WeberLynn. 2010. Understanding Race, Class, Gender, and Sexuality: A Conceptual Framework. 2nd ed.New York: Oxford University Press.
88.
WeberMax. [1922]1946. “Class, Status, Party.” Pp. 180–95 in From Max Weber: Essays in Sociology, edited by GerthH. H.MillsC. W.New York: Oxford University Press.
89.
WilliamsDavid R.2003. “The Health of Men: Structured Inequalities and Opportunities.” American Journal of Public Health93(5):724–31.
90.
WilliamsDavid R.CollinsChiquita. 2001. “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health.” Public Health Reports116(5):404–16.
91.
WilliamsDavid R.MohammedSelina A.2009. “Discrimination and Racial Disparities in Health: Evidence and Needed Research.” Journal of Behavioral Medicine32(1):20–47.
92.
WilliamsDavid. R.MohammedSelina A.2013. “Racism and Health I: Pathways and Scientific Evidence.” American Behavioral Scientist57(8):1152–73.
93.
WillsonAndrea E.ShueyKim M.ElderGlen H.Jr.2007. “Cumulative Advantage Processes as Mechanisms of Inequality in Life Course Health.” American Journal of Sociology112(6):1886–1924.
94.
YangYangLeeLinda C.2009. “Sex and Race Disparities in Health: Cohort Variations in Life Course Patterns.” Social Forces87(4):2093–2124.
95.
ZuberiTukufuBonilla-SilvaEduardo, eds. 2008. White Logic, White Methods: Racism and Methodology. Lanham, MD: Rowman & Littlefield.
