Unfairness and the social gradient of metabolic syndrome in the Whitehall II Study

International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
Journal of Psychosomatic Research (Impact Factor: 2.84). 11/2007; 63(4):413-9. DOI: 10.1016/j.jpsychores.2007.04.006
Source: PubMed

ABSTRACT Little work has investigated the relationship between unfairness and risk factors for heart disease. We examine the role of unfairness in predicting the metabolic syndrome and explaining the social gradient of the metabolic syndrome.
The design is a prospective study with an average follow-up of 5.8 years. Participants were 4128 males and 1715 females of 20 civil service departments in London (Whitehall II study). Sociodemographics, unfairness, employment grade, behavioral risk factors, and other psychosocial factors were measured at baseline (Phase 3, 1991-1993). Waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, fasting glucose, and hypertension were used to define metabolic syndrome at follow-up (Phase 5, 1997-2000), according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines.
Unfairness is positively associated with waist circumference, hypertension, triglycerides, and fasting glucose and negatively associated with serum HDL cholesterol. High levels of unfairness are also associated with the metabolic syndrome [odds ratio (OR)=1.72, 95% CI=1.31-2.25], after adjustment for age and gender. After additional adjustment for employment grade, behavioral risk factors, and other psychosocial factors, the relationship between high unfairness and metabolic syndrome weakened but remained significant (OR=1.37, 95% CI=1.00-1.93). When adjusting for unfairness, the social gradient of metabolic syndrome was reduced by approximately 10%.
Unfairness may be a risk factor for the metabolic syndrome and its components. Future research is needed to study the biological mechanisms linking unfairness and the metabolic syndrome.

    • "These studies raise the possibility that SEP may influence biomarkers in gender-specific ways and through gender-specific pathways. A range of methodological issues threaten the quality of the findings reported from these studies, including: limited measures of SEP, such as dichotomous measure of education and income (Muennig, Sohler et al. 2007); a small number of biological outcomes; a large proportion of missing information on socioeconomic variables particularly income (Loucks, Rehkopf et al. 2007; Pekkanen, Tuomilehto et al. 1995; Seeman, Merkin et al. 2008)) and biomarkers (Loucks, Rehkopf et al. 2007); and, selective samples of work environments (Brunner, Wunsch et al. 2001; De Vogli, Brunner et al. 2007; Heslop, Smith et al. 2001; Ishizaki, Yamada et al. 1999)). In addition, many of the studies dichotomised the biomarkers as below or above a certain threshold as abnormal (e.g. "
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    Social Science [?] Medicine 09/2010; 71(6):1150-60. DOI:10.1016/j.socscimed.2010.05.038 · 2.56 Impact Factor
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    • "In the Survey of MidLife in the United States (MIDUS), perceived discrimination was associated with higher rates of depression in Caucasians than in African Americans (Kessler et al., 1999). In the Whitehall study, perceived unfairness has been related to incident coronary events (De Vogli et al., 2007), incident psychiatric morbidity (Ferrie, 2006), and metabolic syndrome (De Vogli et al., 2007). These studies are not framed within the context of discrimination but unfairness is operationalized with measures similar to those used in the discrimination literature. "
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    • "Accordingly, irrespective of attribution, the perception of unfair treatment may generate distress. For example, in the Whitehall study, perceived unfairness has been related to incident coronary events (De Vogli et al. 2007a), incident psychiatric morbidity (Ferrie et al. 2006), and metabolic syndrome (De Vogli et al. 2007b). These studies were not framed within the context of discrimination but unfairness is operationalized with measures similar to those used in the discrimination literature. "
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