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LETTER |
Arline T. Geronimus, Margaret Hicken, and Danya Keene are with the Department of Health Behavior and Health Education and the Population Studies Center, University of Michigan, Ann Arbor. John Bound is with the Department of Economics and the Population Studies Center, University of Michigan, Ann Arbor, and the National Bureau of Economic Research, Cambridge, Mass.
Correspondence: Requests for reprints should be sent to Arline T. Geronimus, ScD, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109–2029 (e-mail: arline{at}umich.edu).
We see no paradox in the observation that Black women have longer life expectancies than White men, but that Black women experience weathering. Many factors affect life expectancy; weathering is only one. Additionally, morbidity processes influenced by weathering are not always life threatening, and those that are may be managed through secondary and tertiary prevention to avert mortality. The key question about weathering and life expectancy is the extent to which members of different populations experience healthy life expectancy.
When we studied this question,1 we estimated that while Black women had longer life expectancies than their White male counterparts (60 additional years at age 16 compared with 58 additional years), Black women faced shorter active life expectancies than did White men (43 additional years compared with 48 additional years).
When we combined the probabilities of dying with the probabilities of becoming disabled by a given age,2 the differences between Black women and White men favored White men. For example, we predicted the probability of death or disability at age 50 years to be 20% for White men, 30% for Black women, and more than 40% for Black women residing in high-poverty areas. More broadly, we found that increases in life expectancy among White populations are associated with a decrease in the average number of years a person spends in poor health at the end of life.1 We did not find this for Black populations.
Our article on allostatic load scores3 provides evidence that, beginning in young adulthood, Black women have a particularly high risk of suffering multiple morbidities that affect a range of biological systems simultaneously and can include subclinical cases. Moreover, the magnitude of this excess risk becomes more pronounced in middle age. These distressing statistics call for improved understanding of racial health inequalities, their gendered aspects, and efforts to redress them.
While much about the weathering hypothesis remains to be learned, articulated, and tested, and our current understanding leaves many associated puzzles, the relationship between weathering and life expectancy is straightforward.
References
1. Geronimus AT, Bound J, Waidmann TA, Colen CG, Steffick D. Inequality in life expectancy, functional status, and active life expectancy across selected Black and White populations in the United States. Demography. 2001;38:227–251.[ISI][Medline]
2. Geronimus AT, Bound J, Waidmann TA. Health inequality and population variation in fertility-timing. Soc Sci Med. 1999;49:1623–1636.[CrossRef][ISI][Medline]
3. Geronimus AT, Hicken M, Keene D, Bound, J. "Weathering" and age patterns of allostatic load scores among Blacks and Whites in the United States: Am J Public Health. 2006;96:826–833. Published online December 27, 2005. doi:10.2105/AJPH. 2004.060749.
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