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: 2.74). 11/2007; 63(4):413-9. DOI: 10.1016/j.jpsychores.2007.04.006
Source: PubMed


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.

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    • "It has often been shown that those who are worse of in terms of wealth, knowledge and power are also worse off in terms of health. Research on these socioeconomic inequalities in health has progressed over the past few decades and has moved from describing and identifying the problem towards explaining such inequalities and developing interventions to reduce them [1-4]. "
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    ABSTRACT: Background Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health. Methods Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals' self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health. Results People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%. Conclusion Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.
    Archives of Public Health 05/2014; 72(1). DOI:10.1186/2049-3258-72-14
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    • "Recent epidemiologic studies reported that lower SES correlated with a higher prevalence of MS. The 'Whitehall II study' a prospective study over 15 years reported that lower SES increased the incidence of MS 3 to 5 times, in both men and women.13) FRS ≥ 10%, including age, total cholesterol, smoking, high density lipoprotein (HDL)-cholesterol, and systolic blood pressure (SBP) were known to evaluate the risk of CVD incidence within 10 years. "
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    ABSTRACT: The purpose of this study was to examine the association of metabolic syndrome (MS) coronary heart disease (CHD) with socioeconomic status (SES). The participants were 2,170 (631 men and 1,539 women), aged over 40 years who had visited for health screening from April to December in 2009. We classified them into three SES levels according to their education and income levels. MS was defined using the criteria of modified National Cholesterol Education Program Adult Treatment Panel III and CHD risk was defined using Framingham risk score (FRS) ≥ 10%. High, middle, and low SES were 12.0%, 73.7%, and 14.3%, respectively. The prevalence of MS was 18.1%. For high, middle, and low SES, after adjusted covariates (age, drinking, smoking, and exercise), odds ratios for MS in men were 1.0, 1.41 (confidence interval [CI], 0.83 to 2.38; P > 0.05), and 1.50 (CI, 0.69 to 3.27; P > 0.05), respectively and in women were 1.0, 1.74 (CI, 1.05 to 3.18; P < 0.05), and 2.81 (CI, 1.46 to 2.43; P < 0.05), respectively. The prevalence of FRS ≥ 10% was 33.5% (adjusted covariates were drinking, smoking, and exercise) and odds ratios for FRS ≥ 10% in men were 1.0, 2.86 (CI, 1.35 to 6.08; P < 0.001), and 3.12 (CI, 1.94 to 5.00; P < 0.001), respectively and in women were 1.0, 3.24 (CI, 1.71 to 6.12; P < 0.001), and 8.80 (CI, 4.50 to 17.23; P < 0.001), respectively. There was an inverse relationship between SES and FRS ≥ 10% risk in men, and an inverse relationship between SES and both risk of MS and FRS ≥ 10% in women.
    Korean Journal of Family Medicine 03/2013; 34(2):131-8. DOI:10.4082/kjfm.2013.34.2.131
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    • "Furthermore, only few have examined whether this perceived unfairness relates to subsequent poor health outcomes (whether it be through stress-related physiological mechanisms or through engaging in poor health behaviour) [6,7]. Most research in the field addressed injustice and perceived unfairness in the work situation only [8-11] or only used one item to measure perceived general unfairness [6,7]or did not examine perceived unfairness regarding its contribution to socioeconomic inequalities in health [7]. Using seven-year prospective cohort data from the Dutch SMILE study among 55 years olds and older, we set out to examine the contribution of perceived unfairness to the higher risks of physical and mental dysfunction in men and women with a lower socioeconomic position. "
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    ABSTRACT: Background People in lower socioeconomic positions report worse health-related functioning. Only few examined whether perceptions of unfairness are particularly common in these people and whether this perceived unfairness relates to their subsequent poor health outcomes. We thus set out to examine the contribution of perceived unfairness to the higher risks of physical and mental dysfunction in men and women with a lower socioeconomic position. Methods Seven-year prospective cohort data from the Dutch SMILE study among 1,282 persons, 55 years old and older, were used. Physical and mental health-related functioning was measured with the SF-36, socioeconomic status with income and education, and the perception of unfairness with an extended new measure asking for such perceptions in both work and non-work domains. Results Perceived unfairness was more common in lower socioeconomic positions. Such perpection was related to both physical (odds ratio = 1.57 (95% confidence interval: 1.17-2.11)) and mental (1.47 (1.07-2.03)) decline, while low socioeconomic position was only related to mental decline (1.33 (1.06-1.67)). When socioeconomic position and perceived unfairness were simultaneously controlled, odds ratios for both determinants decreased only very little. Socioeconomic position and perceived unfairness were for the largest part independently related to longitudinal health-related decline. Conclusions The general perception of unfairness, at work and beyond work, might have implications for functional decline in middle and older age. We recommend that – rather than addressing and changing individual perceptions of unfairness – more research is needed to find out whether specific environments can be defined as unfair and whether such environments can be effectively tackled in an attempt to truly improve public health.
    BMC Public Health 09/2012; 12(1). DOI:10.1186/1471-2458-12-818 · 2.26 Impact Factor
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