Employment grade and coronary heart disease in British civil servants.

Abstract

SUMMARYThe relationship between grade of employment, coronary risk factors, and coronary heart disease (CHD) mortality has been investigated in a longitudinal study of 17 530 civil servants working in London. After seven and a half years of follow-up there was a clear inverse relationship between grade of employment and CHD mortality. Men in the lowest grade (messengers) had 3-6 times the CHD mortality of men in the highest employment grade (administrators). Men in the lower employment grades were shorter, heavier for their height, had higher blood pressure, higher plasma glucose, smoked more, and reported less leisure-time physical activity than men in the higher grades. Yet when allowance was made for the influence on mortality of all of these factors plus plasma cholesterol, the inverse association between grade of employment and CHD mortality was still strong. It is concluded that the higher CHD mortality experienced by working class men, which is present also in national statistics, can be only partly explained by the established coronary risk factors.A striking feature of the British mortality statistics is that death from coronary heart disease (CHD) is now more common in working class men and women than in those of higher status (Registrar General, 1978). Such vital statistical data have been useful in pointing to occupational groups possibly at high risk. They do not, however, suggest reasons for the class gradient in disease. To identify and, if possible, explain any social class gradient in CHD mortality in a group of employed men, data were analysed from the Whitehall study of civil servants (Reid et al., 1974).The Whitehall study was initiated by Professor Reid. It was based on a survey of male civil servants working in London who were examined between 1967 and 1969, and whose subsequent mortality has been followed (Reid et al., 1976;Rose et al., 1977a

Blood pressure and site-specific cancer mortality: evidence from the original Whitehall study

“…Data collection involved the completion of a study questionnaire and participation in a medical examination, both of which have been described in detail elsewhere (Reid et al, 1974). In brief, the questionnaire included enquiries regarding civil service employment grade (our indicator of socioeconomic position) (Marmot et al, 1978), smoking habits (Reid et al, 1976), intermittent claudication (Rose, 1962;Davey Smith et al, 1990), angina (Rose, 1962;Rose et al, 1977b), chronic bronchitis (Committee on the Aetiology of Chronic Bronchitis, 1965) and use of medication, including blood pressure-lowering drugs. Forced expiratory volume in 1 s (FEV 1 ) (adjusted for height (Batty et al, 2002)), ischaemia (Rose et al, 1977a), fasting plasma cholesterol (Davey Smith et al, 1992), 2-h blood glucose (Jarrett et al, 1986), height (Leon et al, 1995), and weight (Jarrett et al, 1982) were determined using standardised protocols.…”

Socioeconomic status and health: The role of subjective social status

“…People of higher socioeconomic status (SES) live longer, enjoy better health and suffer less from disability, while those of lower SES die younger and suffer a greater burden of disease and disability (Dalstra, Kunst, Borrell, Breeze, Cambois, Costa et al, 2005;Huisman, Kunst, Bopp, Borgan, Borrell, Costa et al, 2005;Mackenbach, Kunst, Cavelaars, Groenhof, Geurts, Andersen et al, 1997;Marmot, Bosma, Hemingway, Brunner, & Stansfeld, 1997;Marmot, Rose, Shipley, & Hamilton, 1978;Minkler, Fuller-Thomson, & Guralnik, 2006). In many cases the associations between SES and health outcomes take the form of a gradient -the higher the SES the better the health (Adler, Boyce, Chesney, Cohen, Folkman, Kahn et al, 1994;Marmot, 2006).…”

Role of socialization in explaining social inequalities in health

“…Reports on socioeconomic inequalities in nineteenth century Europe (Chadwick, 1842; Villermé, 1840) have been followed by research showing the existence of a socioeconomic gradient in health in developed countries (Fox, 1989;Krieger, Williams & Moss, 1997;Marmot, Rose, Shipley & Hamilton, 1978). The Black Report identified four theoretical explanations for social inequalities: artefactual, natural or social selection, materialist/structural, and cultural/behavioural explanations (Townsend & Davidson, 1982).…”