Unfairness and the social gradient of metabolic syndrome in the Whitehall II Study
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.
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- "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. "
ABSTRACT: Socio-economic gradients in cardiovascular disease (CVD) and diabetes have been found throughout the developed world and there is some evidence to suggest that these gradients may be steeper for women. Research on social gradients in biological risk factors for CVD and diabetes has received less attention and we do not know the extent to which gradients in biomarkers vary for men and women. We examined the associations between two indicators of socio-economic position (education and household income) and biomarkers of diabetes and cardiovascular disease (CVD) for men and women in a national, population-based study of 11,247 Australian adults. Multi-level linear regression was used to assess associations between education and income and glucose tolerance, dyslipidaemia, blood pressure (BP) and waist circumference before and after adjustment for behaviours (diet, smoking, physical activity, TV viewing time, and alcohol use). Measures of glucose tolerance included fasting plasma glucose and insulin and the results of a glucose tolerance test (2 h glucose) with higher levels of each indicating poorer glucose tolerance. Triglycerides and High Density Lipoprotein (HDL) Cholesterol were used as measures of dyslipidaemia with higher levels of the former and lower levels of the later being associated with CVD risk. Lower education and low income were associated with higher levels of fasting insulin, triglycerides and waist circumference in women. Women with low education had higher systolic and diastolic BP and low income women had higher 2 h glucose and lower HDL cholesterol. With only one exception (low income and systolic BP), all of these estimates were reduced by more than 20% when behavioural risk factors were included. Men with lower education had higher fasting plasma glucose, 2 h glucose, waist circumference and systolic BP and, with the exception of waist circumference, all of these estimates were reduced when health behaviours were included in the models. While low income was associated with higher levels of 2-h glucose and triglycerides it was also associated with better biomarker profiles including lower insulin, waist circumference and diastolic BP. We conclude that low socio-economic position is more consistently associated with a worse profile of biomarkers for CVD and diabetes for women.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. "
ABSTRACT: Chronic discrimination in both minority and non-minority populations is linked to adverse health outcomes, including increased risk of cardiovascular disease and increased mortality, but the biological processes through which discrimination affects health are unclear. The current study tested the hypothesis that discrimination in a sample of Caucasians would predict elevated serum levels of E-selectin, an indication of endothelial dysfunction which itself is associated with atherosclerosis and cardiovascular disease risk. Participants (N=804) in the biomarker sample from the Survey of Midlife in the United States (MIDUS) provided information about experiences of both major and everyday discrimination at two times separated by a 9-10 year interval. The discrimination measures were designed to assess perceived unfair treatment (e.g. being fired unfairly) independently of the perceived reasons for the unfair treatment (e.g. race, gender). Serum E-selectin was measured at the second wave of data collection. Women reported significantly more instances of major (P<0.05) and everyday P<0.001) discrimination than men. Analyses of Covariance (ANCOVA) showed that both greater lifetime exposure to major discrimination (P<0.05) and chronic exposure to everyday discrimination (P<0.05) predicted higher circulating levels of E-selectin, but only in men. These associations remained statistically significant after adjustments for potential confounding variables, including age, race, socioeconomic status, health status, and health behavior. These results highlight a potential biological mechanism by which exposure to unfair treatment may be related to health, particularly cardiovascular function. Moreover, they add to a growing literature suggesting that unfair treatment in general may predict adverse health outcomes.Brain Behavior and Immunity 02/2009; 23(5):684-92. DOI:10.1016/j.bbi.2009.01.002 · 6.13 Impact Factor
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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. "
ABSTRACT: This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.Journal of Behavioral Medicine 12/2008; 32(1):20-47. DOI:10.1007/s10865-008-9185-0 · 3.10 Impact Factor