Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study

Abstract

Study objective-To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men. Design-25 year follow up of mortality in relation to employment grade. Setting-The first Whitehall study. Participants-18 001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years. Main outcome measure-Specific causes of death. Results-After more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade diVerences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the diVerentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases. Conclusions-DiVerentials in mortality persist at older ages for almost all causes of death.

Socioeconomic position, John Henryism, and incidence of acute myocardial infarction in Finnish men

“…Some evidence suggests that for U.S.-based studies, education and income are stronger predictors of cardiovascular health whereas outside the U.S., occupational status seems to be a stronger predictor (Adler et al, 2008;Havranek et al, 2015;van Rossum et al, 2000). For example, the evidence linking social factors to cardiovascular risk among British civil servants in the Whitehall and Whitehall-II studies was most robust for employment grade (a measure of occupational status unique to civil servants) (van Rossum et al, 2000).…”

Health in an unequal world: social circumstances, biology and disease

“…17 Some estimates put the contribution of smoking higher than that, 86 but these are based on indirect measures that use lung cancer as a proxy measure for smoking and are higher than some other estimates using proxy measures. 87 Whatever the precise contribution of these risk factors to the social gradient, they are important.…”

“…16 Further, the gradient in mortality extended to most of the major causes of death. 17 Most of our attempts at explanation have focused on cardiovascular disease because there has been such a large body of research on the biological pathways involved in coronary heart disease. The real puzzle is why there should be a social gradient in so many different causes of death.…”

Life-course approaches to inequalities in adult chronic disease risk

“…Indeed, when lifetime social circumstances are taken into consideration, the gradient is not mysterious and need not be attributed to psycho-social influences. Marmot et al 1984;Davey Smith et al 1990Van Rossum et al 2000) Administrators …”