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Cited by 1,291Health disparities and outcomesWorkplace Health and Well-beingCardiac Health and Mental Health

Contribution of job control and other risk factors to social variations in coronary heart disease incidence

Marmot, MG, Bosma, H, Hemingway, H, Brunner, E, Stansfeld, S·1997·The Lancet
DOI 10.1016/s0140-6736(97)04244-x
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Abstract

Background The first Whitehall Study showed an inverse social gradient in mortality from coronary heart disease (CHD) among British civil servants--namely, that there were higher rates in men of lower employment grade. About a quarter of this gradient could be attributed to coronary risk factors. We analysed 5-year CHD incidence rates from the Whitehall II study to assess the contribution to the social gradient of psychosocial work environment, social support, coronary risk factors, and physical height.Methods Data were collected in the first three phases of examination of men and women in the Whitehall II study. 7372 people were contacted on all three occasions. Mean length of follow-up was 5.3 years. Characteristics from the baseline, phase 1, questionnaire, and examination were related to newly reported CHD in people without CHD at baseline. Three self-reported CHD outcomes were examined: angina and chest pain from the Rose questionnaire, and doctor-diagnosed ischaemia. The contribution of different factors to the socioeconomic differences in incident CHD was assessed by adjustment of odds ratios.Findings Compared with men in the highest grade (administrators), men in the lowest grade (clerical and office-support staff) had an age-adjusted odds ratio of developing any new CHD of 1.50. The largest difference was for doctor-diagnosed ischaemia (odds ratio for the lowest compared with the highest grade 2.27). For women, the odds ratio in the lowest grade was 1.47 for any CHD. Of factors examined, the largest contribution to the socioeconomic gradient in CHD frequency was from low control at work. Height and standard coronary risk factors made smaller contributions. Adjustment for all these factors reduced the odds ratios for newly reported CHD in the lowest grade from 1.5 to 0.95 in men, and from 1.47 to 1.07 in women.Interpretation Much of the inverse social gradient in CHD incidence can be attributed to differences in psychosocial work environment. Additional contributions were made by coronary risk factors--mainly smoking--and from factors that act early in life, as represented by physical height.

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  • SES gradients in these biological risk parameters are evident as early as the first 5 years of life, throughout childhood, early adolescence, and into early adulthood.

    “Much of the earliest work presented evidence for these SES gradients in adults 12,57 but more recent work has shown that these same SES gradients are evident as early as the first 5 years of life, [58][59][60] as well as throughout childhood, 59,[61][62][63][64][65] early adolescence, [66][67][68] and into early adulthood.[69][70][71][72][73]”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [57]

  • A growing body of evidence documents consistent SES gradients for nearly all major biological risk parameters, with lower SES groups exhibiting higher levels of risk.

    “A growing body of evidence documents consistent SES gradients for nearly all of these biological risk parameters-with lower SES groups exhibiting higher levels of risk.”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [57]

  • Several published reports provide evidence supporting the role of multiple biological systems in mediating SES differentials in mortality.

    “Several published reports provide evidence supporting the role of multiple biological systems in mediating SES differentials in mortality.12,57,85,174”

    From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [57]

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Authors
Marmot, M., Bosma, H., Hemingway, H., Brunner, E., & Stansfeld, S.
Affiliations
University College London (GB)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
1997-07
Volume
350
Issue
9073
Pages
235-239
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(97)04244-x
OpenAlex
W2103716039
Cited by
1,291
References
33
Citations by year
2026: 10 · 2025: 16 · 2024: 32 · 2023: 25 · 2022: 33 · 2021: 21 · 2020: 23 · 2019: 44 · 2018: 29 · 2017: 33 · 2016: 66 · 2015: 49 · 2014: 33 · 2013: 47 · 2012: 45
FWCI
54.71
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • John D. and Catherine T. MacArthur Foundation
  • Agency for Healthcare Research and Quality (5RO1 HS06516)
  • Medical Research Council
  • National Heart, Lung, and Blood Institute (2 RO1 HL 36310, R01HL036310)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
coronary heart disease incidence, social gradient, job control, psychosocial work environment, coronary risk factors, smoking, height, social support, Whitehall II study, public sector employees, occupational grade, ischemia, angina pectoris
MeSH terms
Adult, Body Height, Coronary Disease, Employment, Female, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Power, Psychological, Surveys and Questionnaires, Risk Factors, Social Class, Social Support, Incidence, Odds Ratio

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