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ABSTRACT: PURPOSE: Research on the association between family-to-work and work-to-family conflicts and sleep problems is sparse and mostly cross-sectional. We examined these associations prospectively in three occupational cohorts. METHODS: Data were derived from the Finnish Helsinki Health Study (n = 3,881), the British Whitehall II Study (n = 3,998), and the Japanese Civil Servants Study (n = 1,834). Sleep problems were assessed using the Jenkins sleep questionnaire in the Finnish and British cohorts and the Pittsburgh Sleep Quality Index in the Japanese cohort. Family-to-work and work-to-family conflicts measured whether family life interfered with work or vice versa. Age, baseline sleep problems, job strain, and self-rated health were adjusted for in logistic regression analyses. RESULTS: Adjusted for age and baseline sleep, strong family-to-work conflicts were associated with subsequent sleep problems among Finnish women (OR, 1.33 (95 % CI, 1.02-1.73)) and Japanese employees of both sexes (OR, 7.61 (95 % CI, 1.01-57.2) for women; OR, 1.97 (95 % CI, 1.06-3.66) for men). Strong work-to-family conflicts were associated with subsequent sleep problems in British, Finnish, and Japanese women (OR, 2.36 (95 % CI, 1.42-3.93), 1.62 (95 % CI, 1.20-2.18), and 5.35 (95 % CI, 1.00-28.55), respectively) adjusted for age and baseline sleep problems. In men, this association was seen only in the British cohort (OR, 2.02 (95 % CI, 1.42-2.88)). Adjustments for job strain and self-rated health produced no significant attenuation of these associations. CONCLUSION: Family-to-work and work-to-family conflicts predicted subsequent sleep problems among the majority of employees in three occupational cohorts.
International Journal of Behavioral Medicine 03/2013; · 2.63 Impact Factor
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ABSTRACT: BACKGROUND: Although long working hours are common in working populations, little is known about the effect of long working hours on mental health.MethodWe examined the association between long working hours and the onset of depressive and anxiety symptoms in middle-aged employees. Participants were 2960 full-time employees aged 44 to 66 years (2248 men, 712 women) from the prospective Whitehall II cohort study of British civil servants. Working hours, anxiety and depressive symptoms, and covariates were measured at baseline (1997-1999) followed by two subsequent measurements of depressive and anxiety symptoms (2001 and 2002-2004). RESULTS: In a prospective analysis of participants with no depressive (n=2549) or anxiety symptoms (n=2618) at baseline, Cox proportional hazard analysis adjusted for baseline covariates showed a 1.66-fold [95% confidence interval (CI) 1.06-2.61] risk of depressive symptoms and a 1.74-fold (95% CI 1.15-2.61) risk of anxiety symptoms among employees working more than 55 h/week compared with employees working 35-40 h/week. Sex-stratified analysis showed an excess risk of depression and anxiety associated with long working hours among women [hazard ratios (HRs) 2.67 (95% CI 1.07-6.68) and 2.84 (95% CI 1.27-6.34) respectively] but not men [1.30 (0.77-2.19) and 1.43 (0.89-2.30)]. CONCLUSIONS: Working long hours is a risk factor for the development of depressive and anxiety symptoms in women.
Psychological Medicine 02/2011; · 6.16 Impact Factor
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ABSTRACT: Whether the higher coronary mortality in South Asians compared with White populations is due to a higher incidence of disease is not known. This study assessed cumulative incidence of chest pain in South Asians and Whites, and prognosis of chest pain.
Over seven phases of 18-year follow-up of the Whitehall-II study (9,775 civil servants: 9,195 White, 580 South Asian), chest pain was assessed using the Rose questionnaire. Coronary death/non-fatal myocardial infarction was examined comparing those with chest pain to those with no chest pain at baseline.
South Asians had higher cumulative frequencies of typical angina by Phase 7 (17.0 versus 11.3%, P < 0.001) and exertional chest pain (15.4 versus 8.5%, P < 0.001) compared with Whites. Typical angina and exertional chest pain at baseline were associated with a worse prognosis compared with those with no chest pain in both groups (typical angina, South Asians: HR, 4.67 and 95% CI, 2.12-0.30; Whites: HR, 3.56 95% CI, 2.59-4.88). Baseline non-exertional chest pain did not confer a worse prognosis. Across all types of pain, prognosis was worse in South Asians.
South Asians had higher cumulative incidence of angina than Whites. In both, typical angina and exertional chest pain were associated with worse prognosis compared with those with no chest pain.
Journal of Public Health 11/2010; 33(3):430-8. · 2.06 Impact Factor
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ABSTRACT: British guidelines on vascular disease prevention recommend adding a random (casual) blood glucose measurement to a lipid profile in those aged > or = 40 years. To assess this recommendation, we compared the predictive value of a risk model based on the Framingham risk score alone to one which additionally included information on fasting blood glucose, with respect to incident coronary heart disease (CHD) over 11 years.
Men and women aged 40-63 years in Whitehall II were followed up for incident CHD: death/non-fatal myocardial infarction; angina confirmed by doctor diagnosis or electrocardiogram (ECG) and all first events. Fasting blood glucose was specified as a continuous variable or categorized by World Health Organization (WHO) 1999 glycaemic status (normal glucose tolerance, impaired fasting glucose or newly diagnosed diabetes).
The hazard ratio for incident CHD was 1.10 (95%CI 1.09; 1.12) in men and 1.13 (1.10; 1.17) in women per percentage point increase in Framingham risk. The excess risk remained unchanged in models which added glycaemic status or continuous fasting glucose. The area under the receiver operating characteristic (ROC) curve for the Framingham score and incident coronary heart disease [0.70 (0.68; 0.73)] did not change when glycaemic status or fasting glucose was added to the prediction model. Reclassification with these modified models improved discrimination based on the Framingham score alone when glycaemic status was added, net reclassification improvement 2.4% (95% CI 0.2%; 4.6%), but not when fasting glucose was added.
Better detection of unrecognized diabetes is a valuable consequence of including a random blood glucose in a vascular risk profile. Our results suggest that this strategy is unlikely to improve risk stratification for CHD.
Diabetic Medicine 05/2010; 27(5):550-5. · 2.90 Impact Factor
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ABSTRACT: To compare the performance of nine published strategies for the selection of individuals prior to screening for undiagnosed diabetes.
We conducted a validation study, based on a cross-sectional analysis of 6990 participants of the Whitehall II study, an occupational cohort of civil servants in London. We calculated sensitivity, specificity and the area under the receiver operating characteristic (ROC) curve, indicative of the ability of a risk score to correctly identify those with undiagnosed diabetes.
The prevalence of unknown diabetes was 2.0%. At a set level of sensitivity (0.70), the specificity of the different scores ranged between 0.41 and 0.57. A reference model, based solely on age and body mass index had an area under the ROC curve of 0.67 [95% confidence interval (CI): 0.62, 0.72]. Four scores had a lower area under the ROC curve (lowest ROC AUC: 0.62; 95% CI: 0.58, 0.67) compared with the reference model, while the other five scores had similar areas (highest ROC AUC: 0.68; 95% CI: 0.63, 0.72). All ROC curve areas were lower than those reported in the original publications and validation studies.
Existing risk scores for the detection of undiagnosed diabetes perform less well in a large validation cohort compared with previous validation studies. Our study indicates that non-invasive risk scores require further refinement and testing before they can be used as the first step in a diabetes screening programme.
Diabetic Medicine 01/2010; 27(1):46-53. · 2.90 Impact Factor
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ABSTRACT: Cognitive performance has been associated with mental and physical health, but it is unknown whether the strength of these associations changes with ageing and with age-related social transitions, such as retirement. We examined whether cognitive performance predicted mental and physical health from midlife to early old age.
Participants were 5414 men and 2278 women from the Whitehall II cohort study followed for 15 years between 1991 and 2006. The age range included over the follow-up was from 40 to 75 years. Mental health and physical functioning were measured six times using SF-36 subscales. Cognitive performance was assessed three times using five cognitive tests assessing verbal and numerical reasoning, verbal memory, and phonemic and semantic fluency. Socio-economic status (SES) and retirement were included as covariates.
High cognitive performance was associated with better mental health and physical functioning. Mental health differences associated with cognitive performance widened with age from 39 to 76 years of age, whereas physical functioning differences widened only between 39 and 60 years and not after 60 years of age. SES explained part of the widening differences in mental health and physical functioning before age 60. Cognitive performance was more strongly associated with mental health in retired than non-retired participants, which contributed to the widening differences after 60 years of age.
The strength of cognitive performance in predicting mental and physical health may increase from midlife to early old age, and these changes may be related to SES and age-related transitions, such as retirement.
Psychological Medicine 10/2009; 40(5):837-45. · 6.16 Impact Factor
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ABSTRACT: The psychosocial vulnerability model of hostility posits that hostile individuals, given their oppositional attitudes and behaviours, are more likely to have increased interpersonal conflicts, lower social support, more stressful life events (SL-E) and higher likelihood of depression. However, little research has tested this hypothesis using large-scale prospective samples. The present study aims to assess the predictive value of hostility for depressive mood.
Data are from 3399 participants in the Whitehall II cohort study, aged 35-55 years at baseline (phase 1 1985-1988). Cynical hostility was measured at phase 1. Depressive mood was assessed at phase 7 (2002-2004). Sociodemographic characteristics, health-related behaviours, common mental disorders and antidepressant medication intake were assessed at phase 1. SL-E and confiding/emotional support were measured at phases 1, 2 (1989-1990) and 5 (1997-1999).
Compared with participants in the lowest quartile of cynical hostility, those in the highest quartiles were more likely to have depressive mood [second quartile: odds ratio (OR) 1.58, 95% confidence interval (CI) 1.14-2.20; third quartile: OR 2.78, 95% CI 2.03-3.77; fourth quartile: OR 4.66, 95% CI 3.41-6.36] in analysis adjusted for sociodemographic characteristics. This graded association was somewhat attenuated (18%) but remained robust to adjustments for the covariates measured at baseline and follow-up. The association was also evident in participants free of mental health difficulties at baseline.
Cynical hostility is a strong and robust predictor of depressive mood. Consideration of personality characteristics may be crucial to the understanding and management of depression.
Psychological Medicine 08/2009; 40(3):405-13. · 6.16 Impact Factor
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ABSTRACT: Cognitive and physical functions are closely linked in old age, but less is known about this association in midlife. Whether cognitive function predicts physical function and whether physical function predicts cognitive function were assessed in middle-aged men and women.
Data were from Whitehall II, an ongoing large-scale, prospective occupational cohort study of employees from 20 London-based white-collar Civil Service departments. The participants, 3446 men and 1274 women aged 45-68 years at baseline (1995-1997), had complete data on cognitive performance and physical function at both baseline and follow-up (2002-2004). A composite cognitive score was compiled from the following tests: verbal memory, inductive reasoning (Alice Heim 4-I), verbal meaning (Mill Hill), phonemic and semantic fluency. Physical function was measured using the physical composite score of the short form (SF-36) scale. Average follow-up was 5.4 years.
Poor baseline cognitive performance predicted poor physical function at follow-up (beta = 0.08, p<0.001), while baseline physical function did not predict cognitive performance (beta = 0.01, p = 0.67). After full adjustment for sociodemographic, behavioural and biological risk factors, baseline cognitive performance (beta = 0.04 p = 0.009) remained predictive of physical function.
Despite previous work indicating that the association between physical and cognitive performance may be bidirectional, these findings suggest that, in middle age, the direction of the association is predominantly from poor cognition to poor physical function.
Journal of epidemiology and community health 06/2009; 63(6):468-73. · 3.04 Impact Factor
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ABSTRACT: The cardioprotective properties of moderate alcohol consumption, compared with abstinence or heavy drinking, are widely reported, but whether the benefits are experienced equally by all moderate drinkers is less well known.
To examine the association between average alcohol intake per week and the incidence of fatal and non-fatal myocardial infarction during 17 years of follow-up for 9655 men and women without prevalent disease in the general population; and to test whether the level of cardioprotection differs according to subjects' other health behaviours (healthy, moderately healthy, unhealthy) at entry to the study.
A longitudinal, British civil service-based cohort study, baseline in 1985-8.
A significant benefit of moderate drinking compared with abstinence or heavy drinking was found among those with poor health behaviours (little exercise, poor diet and smokers). No additional benefit from alcohol was found among those with the healthiest behaviour profile (> or =3 hours of vigorous exercise per week, daily fruit or vegetable consumption and non-smokers).
The cardioprotective benefit from moderate drinking does not apply equally to all drinkers, and this variability should be emphasised in public health messages.
Journal of epidemiology and community health 11/2008; 62(10):905-8. · 3.04 Impact Factor
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ABSTRACT: Obesity has been implicated in the aetiology of liver disease. However, to date, evidence is largely drawn from cross-sectional studies, where interpretation is hampered by reverse causality, and from studies on clinical populations that have limited generalisability. In this prospective cohort study, data on body mass index (BMI) and covariates were collected at baseline on 18 863 male government employees (aged 40-69 years). Respondents were then followed up for a maximum of 38 years of age. Mortality surveillance gave rise to 13 129 deaths, 122 of which were due to liver disease (57 cancers; 65 non-cancers). In age-adjusted analyses, BMI was positively related to total liver disease mortality (hazards ratio per 1 s.d. increase in BMI; 95% confidence interval (CI): 1.36; 1.14, 1.62) in a graded fashion across the weight categories (P-value for trend: 0.01). The magnitude of this association was somewhat stronger for non-cancer liver disease deaths (1.47; 1.16, 1.86) than for cancer liver disease deaths (1.25; 0.96, 1.62). Excluding deaths in the first 10 years of follow-up somewhat strengthened the BMI-non-cancer liver disease association. Adjustment for socioeconomic position, other candidate confounders and mediating factors led to the modest attenuation of these associations. Further investigation in prospective cohort studies with more detailed data on liver disease, for instance using biochemical tests of liver function or hepatic ultrasonography, is warranted.
International journal of obesity (2005) 10/2008; 32(11):1741-4. · 4.34 Impact Factor
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ABSTRACT: While individuals with diabetes have a raised risk of stroke, it is unclear whether hyperglycaemia in non-diabetic populations is related to the development of this disease.
In this prospective cohort study of 19,019 men, capillary blood was drawn 2 h after consumption of a glucose preparation equivalent to 50 g of anhydrous dextrose. Study participants were then followed for mortality for a maximum of 38 years.
During follow-up of 18,406 non-diabetic men, 13,116 deaths occurred (1,189 by stroke). Plots of stroke mortality rates versus blood glucose identified an upward inflection in risk of death from stroke at about 4.6 mmol/l. This upward inflection in risk could be adequately described using a single linear term above this threshold. A 1 mmol/l increase in blood glucose after this point was associated with a 27% increase in risk of death from stroke (hazard ratio 1.27, 95% CI 1.14-1.42). This increase in risk was partially attenuated by adjustment for covariates (1.17, 1.04-1.31) but remained statistically significant at conventional levels. Similar observations were made when all-cause mortality was the outcome of interest, although the magnitude of the association with blood glucose was somewhat lower.
An incremental elevation in stroke mortality rates occurs with increasing post-challenge blood glucose.
Diabetologia 08/2008; 51(7):1123-6. · 6.81 Impact Factor
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D Gimeno,
M Kivimäki,
E J Brunner,
M Elovainio,
R De Vogli,
A Steptoe,
M Kumari,
G D O Lowe,
A Rumley, M G Marmot,
J E Ferrie
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ABSTRACT: A lack of longitudinal studies has made it difficult to establish the direction of associations between circulating concentrations of low-grade chronic inflammatory markers, such as C-reactive protein and interleukin-6, and cognitive symptoms of depression. The present study sought to assess whether C-reactive protein and interleukin-6 predict cognitive symptoms of depression or whether these symptoms predict inflammatory markers.
In a prospective occupational cohort study of British white-collar civil servants (the Whitehall II study), serum C-reactive protein, interleukin-6 and cognitive symptoms of depression were measured at baseline in 1991-1993 and at follow-up in 2002-2004, an average follow-up of 11.8 years. Symptoms of depression were measured with four items describing cognitive symptoms of depression from the General Health Questionnaire. The number of participants varied between 3339 and 3070 (mean age 50 years, 30% women) depending on the analysis.
Baseline C-reactive protein (beta=0.046, p=0.004) and interleukin-6 (beta=0.046, p=0.005) predicted cognitive symptoms of depression at follow-up, while baseline symptoms of depression did not predict inflammatory markers at follow-up. After full adjustment for sociodemographic, behavioural and biological risk factors, health conditions, medication use and baseline cognitive systems of depression, baseline C-reactive protein (beta=0.038, p=0.036) and interleukin-6 (beta=0.041, p=0.018) remained predictive of cognitive symptoms of depression at follow-up.
These findings suggest that inflammation precedes depression at least with regard to the cognitive symptoms of depression.
Psychological Medicine 07/2008; 39(3):413-23. · 6.16 Impact Factor
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ABSTRACT: The relation between cigarette smoking and several malignancies is still unclear. We examined the association of cigarette smoking with death attributed to 15 cancer sites, 7 of which are regarded as having an uncertain relation with tobacco.
The original Whitehall study is a prospective cohort of 17 363 London-based male government employees (age 40-69 years) who were examined in the late 1960s and then followed up for a maximum of 38 years.
Following adjustment for demographic characteristics, risk factors, and prevalent disease, established positive cigarette smoking--cancer gradients were confirmed for carcinoma of the lung, stomach, pancreas, bladder, upper aero-digestive (including oesophagus), and liver, and for myeloid leukaemia. Among the cancers of uncertain relation with smoking, mortality rates for malignancy of the colon, rectum and prostate and for lymphatic leukaemia were elevated in current and/or former smokers. There was essentially no apparent relation between smoking and mortality from carcinoma of the brain or from lymphoma.
In this study, cigarette smoking appears to be a risk factor for several malignancies of previously unclear association with tobacco use.
Annals of Oncology 06/2008; 19(5):996-1002. · 6.43 Impact Factor
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ABSTRACT: Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice.
To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men.
Data are from the Whitehall II study, a prospective cohort of 10 308 white-collar British civil servants (3143 women and 6895 men, aged 35-55 at baseline) (Phase 1, 1985-88). Employment grade, relational justice, job demands, job control, social support at work, effort-reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989-90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991-93) among participants case-free at baseline.
In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort-reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3).
This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers' duty to ensure that employees are treated fairly at work also has benefits for health.
Occupational and environmental medicine 08/2006; 63(7):443-50. · 3.64 Impact Factor
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ABSTRACT: To examine the relations between obesity or overweight and coronary heart disease (CHD) mortality in men with and without prevalent CHD in a prospective cohort study.
In the Whitehall study of London-based male government employees, 18 403 middle age men were followed up for a maximum of 35 years having participated in a medical examination in the late 1960s in which weight, height, CHD status, and a range of other social, physiological, and behavioural characteristics were measured.
In age-adjusted analyses of men with baseline CHD there was a modest raised risk in the overweight relative to normal weight groups for all cause mortality (hazard ratio 1.10, 95% confidence interval (CI) 1.00 to 1.20) and CHD mortality (1.28, 95% CI 1.11 to 1.47) but not for stroke mortality (1.01, 95% CI 0.73 to 1.40). Mortality was similarly raised in the obese group. While these slopes were much steeper in men who were apparently CHD-free at study induction, the difference in the gradients according to baseline CHD status did not attain significance at conventional levels (p value for interaction >or= 0.24). The weight-mortality relations were somewhat attenuated when potential mediating and confounding factors were added to the multivariable models in both men with and men without a history of CHD.
Avoidance of obesity and overweight in adult life in men with and without CHD may reduce their later risk of total and CHD mortality.
Heart (British Cardiac Society) 07/2006; 92(7):886-92. · 4.22 Impact Factor
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ABSTRACT: Previous research has focused on overall associations between work stress and body mass index (BMI) ignoring the possibility that stress may cause some people to eat less and lose weight and others to eat more. Using longitudinal data, we studied whether work stress induced weight loss in lean individuals and weight gain in overweight individuals.
Prospective cohort study.
A total of 7965 British civil servants (5547 men and 2418 women) aged 35-55 at study entry (The Whitehall II study).
Work stress, indicated by the job strain model and measured as job control, job demands and job strain, was assessed at baseline and BMI at baseline and at 5-year follow-up.
In men, the effect of job strain on weight gain and weight loss was dependent on baseline BMI (P</=0.03). In the leanest quintile (BMI<22 kg/m(2)) at baseline, high job strain and low job control were associated with weight loss by follow-up, whereas among those in the highest BMI quintile (>27 kg/m(2)), these stress indicators were associated with subsequent weight gain. No corresponding interaction was seen among women.
Inconsistent findings reported by previous studies of stress and BMI have generally been interpreted to indicate the absence of an association. In light of our results, the possibility of differential effects of work stress should also be taken into account.
International Journal of Obesity 07/2006; 30(6):982-7. · 4.69 Impact Factor
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ABSTRACT: Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS.
Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study--an ongoing health survey of office based civil servants. A self-report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42-62 years working in 44 buildings were included in this study.
No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non-significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis.
The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.
Occupational and environmental medicine 05/2006; 63(4):283-9. · 3.64 Impact Factor
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ABSTRACT: Adult height has been related to organ-specific malignancies in relatively few studies. Findings are discrepant for some sites and several studies are subject to a series of methodological limitations.
We examined the association of adult height with death attributed to 14 cancer sites using data from the original Whitehall cohort. This is a prospective study of 18,403 middle-aged, non-industrial, London-based, male government employees who were examined in the late 1960s and then followed up for mortality for a maximum of 35 years.
There were 11,099 deaths during follow-up, 3101 (28%) of which were ascribed to cancer. Cox proportional hazards regression models revealed modest effects for height in relation to site-specific cancers. Following adjustment for covariates that included employment grade (an indicator of socioeconomic position), body mass index and smoking habit, increased height was associated with elevated mortality rates for cancer of combined sites [hazards ratio per 5 cm increase in height (95% confidence interval); P for trend across height categories: 1.05 (1.03, 1.08); P < 0.001], lung [1.13 (1.06, 1.20); P < 0.001], prostate [1.07 (0.99, 1.15); P = 0.08], kidney [1.20 (0.99, 1.46); P = 0.08], skin [1.35 (1.06, 1.70); P = 0.02] and leukaemia [1.11 (0.96, 1.28); P = 0.02].
Amongst other explanations, the weak positive height-cancer gradients apparent herein may be ascribed to early life exposures that correlate with adult height, such as high caloric intake.
Annals of Oncology 02/2006; 17(1):157-66. · 6.43 Impact Factor
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ABSTRACT: To examine the relation of obesity and overweight with organ-specific cancer mortality.
In the Whitehall prospective cohort study of London-based government employees, 18 403 middle-age men participated in a medical examination between 1967 and 1970. Subjects were followed up for cause-specific mortality for up to 35 y (median: interquartile range (25th-75th centile); 28.1 y: 18.6-33.8).
There were over 3000 cancer deaths in this cohort. There was a raised risk of mortality from carcinoma of the rectum, bladder, colon, and liver, and for lymphoma in obese or overweight men following adjustment for range of covariates, which included socioeconomic position and physical activity. These relationships held after exclusion of deaths occurring in the first 20 y of follow-up.
Avoidance of obesity and overweight in adult life may reduce the risk of developing some cancers.
International Journal of Obesity 11/2005; 29(10):1267-74. · 4.69 Impact Factor
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ABSTRACT: Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors.
The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination.
Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%.
We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.
International Journal of Epidemiology 07/2005; 34(3):640-8. · 6.41 Impact Factor
