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Objective: Ethnic differences in cardiovascular disease incidence, but not cardiovascular disease recurrence, are reported. We characterised long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a British cohort of South Asians, African Caribbeans and Europeans.Methods: We identified index and recurrent cardiovascular events and mortality between 1988 and 2017 using hospital records and death registry. Using multivariable hazards models, we separately calculated the adjusted HR of MACE and death following index event, adjusting for demographics, vascular and lifestyle risk factors. Using interaction terms, we evaluated if decade of index event modified the association between ethnicity and outcomes.Results: South Asians were younger at the index event (median age 66 years, n=396) than Europeans (69 years, n=335) and African Caribbeans (70 years, n=70). During 4228 person-years, of the 801 patients, 537 developed MACE and 338 died, with the highest crude rate of MACE in South Asians. On adjustment of baseline factors, compared with the Europeans, the higher risk of MACE (HR 0.97, 95% CI 0.77 to 1.21) and the lower risk of mortality (HR 0.95, 95% CI 0.72 to 1.26) in South Asians was eliminated. African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 95% CI 0.74 to 1.47; and HR death 1.07, 95% CI 0.70 to 1.64). Long-term survival following an index event improved in South Asians (ptrend 0.02) and African Caribbeans (ptrend 0.07) compared with Europeans.Conclusions: Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time. [ABSTRACT FROM AUTHOR]

Background The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes. Methods and results We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest. Conclusions Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented. [ABSTRACT FROM AUTHOR]

Background Despite the importance of socioeconomic position for survival, total wealth, which is a measure of accumulation of assets over the life course, has been underinvestigated as a predictor of mortality. We investigated the association between total wealth and mortality at older ages. Methods We estimated Cox proportional hazards models using a sample of 10 305 community-dwelling individuals aged ≥50 years from the English Longitudinal Study of Ageing. Results 2401 deaths were observed over a mean follow-up of 9.4 years. Among participants aged 50-64 years, the fully adjusted HRs for mortality were 1.21 (95% CI 0.92 to 1.59) and 1.77 (1.35 to 2.33) for those in the intermediate and lowest wealth tertiles, respectively, compared with those in the highest wealth tertile. The respective HRs were 2.54 (1.27 to 5.09) and 3.73 (1.86 to 7.45) for cardiovascular mortality and 1.36 (0.76 to 2.42) and 2.53 (1.45 to 4.41) for other non-cancer mortality. Wealth was not associated with cancer mortality in the fully adjusted model. Similar but less strong associations were observed among participants aged ≥65 years. The use of repeated measurements of wealth and covariates brought about only minor changes, except for the association between wealth and cardiovascular mortality, which became less strong in the younger participants. Wealth explained the associations between paternal occupation at age 14 years, education, occupational class, and income and mortality. Conclusions There are persisting wealth inequalities in mortality at older ages, which only partially are explained by established risk factors. Wealth appears to be more strongly associated with mortality than other socioeconomic position measures. [ABSTRACT FROM AUTHOR]

The article focuses on findings of a study related to childhood survival in Great Britain, as of October 2010. It states that the Millennium Development Goal of United Nations have significantly helped improve childhood survival in the country by reducing mortality among children under the age of five, and cites the trends in child mortality in Great Britain and Europe. It mentions possible reasons for higher child and adolescent mortality like poverty and socioeconomic inequalities.

Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002-2005) included 16 812 men and 19 180 women aged 45-69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU. [ABSTRACT FROM AUTHOR]

Background A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. Methods Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. Results Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. Conclusions Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk. [ABSTRACT FROM AUTHOR]

Objective To determine whether the effect of South Asian ethnicity differs between studies of incidence and prognosis of coronary disease. Design Systematic literature review and meta-analysis, and cohort analysis from a national acute coronary syndrome (ACS) registry linked to mortality (National Institute of Cardiovascular Outcomes Research/ Myocardial Infarction National Audit Project). Setting International for the review, and England and Wales for the cohort analysis. Patients The numbers of South Asians included in the meta-analysis were 111 555 (incidence) and 14 531 (prognosis) of whom 8251 were from the ACS cohort. Main outcome measures Incidence studies: non-fatal myocardial infarction or fatal coronary heart disease; prognostic studies: mortality; HRs for 1-year allcause death in ACS cohort. Results South Asians had higher incidence of coronary disease compared with white subjects (HR 1.35 95% CI 1.30 to 1.40) based on meta-analysis of nine studies. Among 10 studies on prognosis, South Asians had better prognosis compared with white subjects (HR 0.78 95% CI 0.74 to 0.82). In the ACS cohort, the impact of diabetes (42.4% of South Asians, 16.9% of white subjects) on 1-year mortality was stronger in South Asians than white subjects (age-adjusted HR 1.83 95% CI 1.59 to 2.11 vs 1.53 95% CI 1.49 to 1.57). However, prognosis was better in South Asians even among diabetics, older people and hose living in areas of the highest social deprivation. Conclusions South Asian ethnicity is associated with higher incidence of coronary disease, but lower mortality once coronary disease is manifest. The dissociation between effects on incidence and prognosis suggests that public health initiatives to reduce inequalities in mortality between South Asian and white populations should focus on primary prevention. [ABSTRACT FROM AUTHOR]

Background Little is known about the role that work-related factors play in the decline of cognitive function. This study examined the association between perceived organisational justice and cognitive function among middle-aged men and women. Methods Perceived organisational justice was measured at phases 1 (1985e8) and 2 (1989e90) of the Whitehall II study when the participants were 35e55 years old. Assessment of cognitive function at the screening clinic at phases 5 (1997e9) and 7 (2003e4) included the following tests in the screening clinic: memory, inductive reasoning (Alice Heim 4), vocabulary (Mill Hill), and verbal fluency (phonemic and semantic). Mean exposure to lower organisational justice at phases 1 and 2 in relation to cognitive function at phases 5 and 7 were analysed using linear regression analyses. The final sample included 4531 men and women. Results Lower mean levels of justice at phases 1 and 2 were associated with worse cognitive function in terms of memory, inductive reasoning, vocabulary and verbal fluency at both phases 5 and 7. These associations were independent of covariates, such as age, occupational grade, behavioural risks, depression, hypertension and job strain. Conclusions This study suggests an association between perceived organisational justice and cognitive function. Further studies are needed to examine whether interventions designed to improve organisational justice would affect employees' cognition function favourably. [ABSTRACT FROM AUTHOR]

Background Occupational work involves many factors capable of protecting cognition. The 'disuse' hypothesis suggests that removal of such factors at retirement may increase the risk of cognitive decline. Objective To examine whether retirement is significantly associated with cognitive change after adjusting for preretirement cognitive function, personal, social, health and lifestyle factors, work characteristics and leisure activity. Methods Participants were from the Whitehall II study, a prospective study of London-based Civil Servants. Short-term memory, the AH4 Part 1 (a test of inductive reasoning), verbal fluency and the Mill Hill Vocabulary Scale were collected at ages 38-60 years, and again, on average 5 years later, at 42-67 years, providing pre- and postretirement cognitive functioning assessments for 2031 participants (470 retired and 1561 working). Linear regression was used to test the association between retirement and cognitive performance adjusted for preretirement cognition. Results Mean cognitive test scores increased between the two assessments. However, after adjusting for age, sex, education, occupational social class, Mill Hill score, work characteristics, leisure activities, and indicators of physical and mental health, those retired showed a trend towards smaller test score increases over 5 years than those still working, although this only reached 5% significance in one test (AH4; β=-0.7, 95% CI 1.2 to -0.09) and did not show a dose-response effect with respect to length of time in retirement. Conclusions This trend is consistent with the disuse hypothesis but requires independent replication before it can be accepted as supportive in this respect. [ABSTRACT FROM AUTHOR]

Background Modifiable behavioural risk factors--including exercise, obesity and smoking--have been causally associated with colorectal cancer mortality. However, results have been inconsistent and undiagnosed cancers may affect baseline risk factors, distorting the temporal relationship that is observed between them. Objective To determine whether risk factors for colorectal cancers available in the Whitehall I study were predictive of colonic or rectal cancer mortality. Methods Prospective cohort study over 40 years on Whitehall I men aged 40-69 on entry between 1967 and 1970. Associations between baseline risk factors and cause-specific mortality were tested with Cox proportional hazards models. Events within the first 10 years of follow-up were excluded to minimise 'reverse causality.' Results 329 colon and 121 rectal cancer deaths occurred among 17 949 men followed up for a total of 472 523 person-years. Age and smoking were associated with increased mortality from colorectal cancers. Compared with never-smokers, current smoking was associated with age-adjusted HRs for colon and rectal cancers of 1.45 (95% CI 1.03 to 2.03) and 1.97 (95% CI 1.02 to 3.80), respectively. A significant effect of current smoking on rectal cancer mortality was only apparent after events in the first 10 years of follow-up were excluded. No convincing evidence was found that body mass index, diabetes mellitus, blood pressure or physical activity were associated with colorectal cancer mortality. Conclusion Smoking significantly increases mortality from colorectal cancer and its decreasing prevalence in the UK may partly explain falling mortality from the disease. Changes in health behaviours in response to early cancer symptoms may result in differential misclassification or 'reverse causality' unless early events are excluded. Although many individual cohort studies have not shown significant relationships between behavioural risk factors and colorectal cancer mortality, their contribution to meta-analyses remains important. [ABSTRACT FROM AUTHOR]

Background Although several plausible biological mechanisms have been advanced for the associationbetween greater physical stature and lower coronary heart disease (CHD) risk in prospective cohort studies, the importance of one of the principal artefactual explanations dreverse causality due to shrinkaged remains unresolved. To explore this issue, studies with repeat measurements of height arerequired, but, to date, such data have been lacking. Objective To examine the possible relationship between height loss and future CHD. Methods Data were analysed from the Whitehall II prospective cohort study of 3802 men and 1615 women who participated in a physical examination in 1985e8, had their height re-measured in 1997e9, and were then followed up for fatal and non-fatal CHD. Results A mean follow-up of 7.4 years after the second height measurement gave rise to 69 CHD events in men and 18 in women. After adjustment for baseline CHD risk factors, greater loss of physical stature between survey and resurvey was associated with an increased risk of CHD in men (HR; 95% CI for a one SD increase: 1.24; 1.00 to 1.53) but not women (0.93; 0.58 to 1.50). Conclusions Reverse causality due to shrinkage may contribute to the inverse association between a single measurement of height and later CHD in other studies. [ABSTRACT FROM AUTHOR]

Background Depression and mortality have been studied separately in patients with coronary heart disease (CHD) and in populations healthy at study inception. This does not allow comparisons across risk-factor groups based on the cross-classification of depression and CHD status. Objective To examine effects of depressive symptoms and CHD and their interactive associations on mortality in middle-aged adults followed over 5.6 years. Design and setting A prospective population-based cohort study of 5936 middle-aged men and women from the British Whitehall II study. We created four risk-factor groups based on the cross-classification of depressive symptoms and CHD status. Results The age-adjusted and sex-adjusted hazard ratios for death from all causes were 1.67 (p<0.05) for participants with only CHD, 2.10 (p<0.001) for those with only depressive symptoms and 4.99 (p<0.001) for those with both CHD and depressive symptoms when compared to participants without either condition. The two latter risk-factor groups remained at increased risk after adjustments for relevant confounders. The relative excess risk due to the interaction between depressive symptoms and CHD for all-cause mortality was 3.58 (95% CI ?0.09 to 7.26), showing some evidence of an additive interaction. A similar pattern was also observed for cardiovascular death. Conclusions This study provides evidence that depressive symptoms are associated with an increased risk of all-cause and cardiovascular death and that this risk is particularly marked in depressive participants with co-morbid CHD. [ABSTRACT FROM AUTHOR]

The article explores the association between unemployment, poor working conditions and health and stresses the importance for governments and public health agencies to recognize that fair employment conditions should be regarded as a human right. It explains how globalisation increases working condition inequalities and social inequalities in health. The influence of the political tradition of a country on its labour laws, regulations and level of social protection is analyzed. It also describes how economic crises affect the health of workers. INSET: EVIDENCE ON EMPLOYMENT CONDITIONS AND HEALTH.

Objective Extended walking speed is a predictor of incident cardiovascular disease (CVD) in older individuals, but the ability of an objective short-distance walking speed test to stratify the severity of preclinical conditions remains unclear. This study examined whether performance in an 8-ft walking speed test is associated with metabolic risk factors and subclinical atherosclerosis. Design Cross-sectional. Setting Epidemiological cohort. Participants 530 adults (aged 63±6 years, 50.3% male) from the Whitehall II cohort study with no known history or objective signs of CVD. Main outcome Electron beam computed tomography and ultrasound was used to assess the presence and extent of coronary artery calcification (CAC) and carotid intima-media thickness (IMT), respectively. Results High levels of CAC (Agatston score >100) were detected in 24% of the sample; the mean IMT was 0.75 mm (SD 0.15). Participants with no detectable CAC completed the walking course 0.16 s (95% CI 0.04 to 0.28) faster than those with CAC =400. Objectively assessed, but not self-reported, faster walking speed was associated with a lower risk of high CAC (odds ratio 0.62, 95% CI 0.40 to 0.96) and lower IMT (β=-0.04, 95% CI -0.01 to -0.07 mm) in comparison with the slowest walkers (bottom third), after adjusting for conventional risk factors. Faster walking speed was also associated with lower adiposity, C-reactive protein and low-density lipoprotein cholesterol. Conclusions Short-distance walking speed is associated with metabolic risk and subclinical atherosclerosis in older adults without overt CVD. These data suggest that a non-aerobically challenging walking test reflects the presence of underlying vascular disease. [ABSTRACT FROM AUTHOR]

Objectives Low organisational justice has been shown to be associated with increased risk of various health problems, but the underlying mechanisms remain unclear. We tested whether organisational injustice contributes to chronic inflammation in a population of middle-aged men and women. Methods This prospective cohort study uses data from 3205 men and 1204 women aged 35-55 years at entry into the Whitehall II study (phase 1, 1985-1988). Organisational justice perceptions were assessed at phase 1 and phase 2 (1989-1990) and circulating inflammatory markers C-reactive protein (CRP) and interleukin (IL)-6 at phase 3 (1991-1993) and phase 7 (2003-2004). Results In men, low organisational justice was associated with increased CRP levels at both follow-ups (phase 3 and 7) and increased IL-6 at the second follow-up (phase 7). The long term (phase 7) associations were largely independent of covariates, such as age, employment grade, body mass index and depressive symptoms. In women, no relationship was found between organisational justice and CRP or IL-6. Conclusions This study suggests that organisational injustice is associated with increased long-term levels of inflammatory markers among men. [ABSTRACT FROM AUTHOR]

Objectives To examine potential reciprocal associations between common mental disorders and obesity, and to assess whether dose-response relations exist. Design Prospective cohort study with four measures of common mental disorders and obesity over 19 years (Whitehall II study). Setting Civil service departments in London. Participants 4363 adults (28% female, mean age 44 years at baseline). Main outcome Common mental disorder defined as general health questionnaire "caseness;" overweight and obesity based on Word Health Organization definitions. Results In models adjusted for age, sex, and body mass index at baseline, odds ratios for obesity at the fourth screening were 1.33 (95% confidence interval 1.00 to 1.77), 1.64 (1.13 to 2.36), and 2.01 (1.21 to 3.34) for participants with common mental disorder at one, two, or three preceding screenings compared with people free from common mental disorder (P for trend<0.001). The corresponding mean differences in body mass index at the most recent screening were 0.20, 0.31, and 0.50 (P for trend<0.001). These associations remained after adjustment for baseline characteristics related to mental health and exclusion of participants who were obese at baseline. In addition, obesity predicted future risk of common mental disorder, again with evidence of a dose-response relation (P for trend=0.02, multivariable model). However, this association was lost when people with common mental disorder at baseline were excluded (P for trend=0.33). Conclusions These findings suggest that in British adults the direction of association between common mental disorders and obesity is from common mental disorder to increased future risk of obesity. This association is cumulative such that people with chronic or repeat episodes of common mental disorder are particularly at risk of weight gain. [ABSTRACT FROM AUTHOR]

Objective: To assess the receipt of effective healthcare interventions in England by adults aged 50 or more with serious health conditions. Design: National structured surveyquestionnaírewith face to face interviews covering medical panel endorsed quality of care indicators for both publicly and privately provided care. Setting: Private households across England. Participants 8688 participants in the study of ageing, of whom 4417 reported diagnoses of one or more of 13 conditions. Main outcome measures Percentage of indicated interventions received by eligible participants for 32 clinical indicators and seven questions on patient centred care, and aggregate scores. Results: Participants were Eligible for 19 082 items of indicated care. Receipt of indicated care varied substantially by condition. The percentage of indicated care received by eligible participants was highest for ischaemic heart disease (83%, 95% confidence interval 80% to 86%), followed by hearing problems (79%, 77% to 76%), pain management (78%, 73% to 83%), diabetes (74%, 72% to 76%), smoking cessation (74%, 71% to 76%), hypertension (72%, 69% to 76%) , stroke (65%, 54% to 63%), depression (64%, 57% to 70%), patient centred care (58%, 47% to 54%), poor vision (58%, 54% to 63%), osteoporosis (53%, 49% to 54%), urinary incontinence (51%, 47% to 54%), falls management (44%, 37% to 51%), osteoarchritis (29%, 26% to 32%), and overall (62%, 62% to 63%). Substantially more indicated care was received for general medical (74%, 73% to 76%) than for conditions included in the general practice pay for performance contract (75%, 73% to 76%)than excluded from it (58%, 56% to 59%). Conclusion: Shortfalls in receipt of basic recommended care by adult aged 50 or more with common health conditions in England were most noticeable in areas associated with disability and frailty, but few areas were exempt. Effort to improve care have substantial scope to achieve better health outcomes and particularty need to include chronic conditions that affect quality of life of older people [ABSTRACT FROM AUTHOR]

Objective To examine the associations between positive and negative affect and subsequent coronary heart disease events independently of established risk factors. Design Prospective cohort study with follow-up over 12 years. Setting 20 civil service departments originally located in London. Participants 10 308 civil servants aged 35-55 years at entry into Whitehall II study in 1985. Main outcome measures Fatal coronary heart disease, clinically verified incident non-fatal myocardial infarction, and definite angina (n=619, mean follow-up 12.5 years). Results In Cox regression analysis adjusted for age, sex, ethnicity, and socioeconomic position, positive affect (hazard ratio=1.01,95% confidence interval 0.82 to 1.24) and the balance between positive and negative affect, referred to as the affect balance score (hazard ratio=0.89, 0.73 to 1.09), were not associated with coronary heart disease. Further adjustment for behaviour related risk factors (smoking, alcohol consumption, daily fruit and vegetable intake, exercise, body mass index), biological risk factors (hypertension, blood cholesterol, diabetes), and psychological stress at work did not change these results. However, participants in the highest third of negative affect had an increased incidence of coronary events (hazard ratio=1.32,1.09 to 1.60), and this association remained unchanged after adjustment for multiple confounders. Conclusions Positive affect and affect balance did not seem to be predictive of future coronary heart disease in men and women who were free of diagnosed coronary heart disease at recruitment to the study. A weak positive association between negative affect and coronary heart disease was found and needs to be confirmed in further studies. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Design: Multilevel analysis of cross-sectional data. Setting: 13 Countries from Central and Eastern Europe and the former Soviet Union. Participants: Population samples aged 18+ years (a total of 15 331 respondents). Mean outcome measures: Poor self-rated health. Results: There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age-and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r= -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1 .1 5 (95% confidence interval 1 .03 to 1 .29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Conclusion: Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of unfairness on incident coronary events and health functioning. Design: Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort-reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow-up of 10.9 years. Participants: 5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study). Main outcome measures: Incident fatal coronary heart disease, non-fatal myocardial infarction and angina (528 events) and health functioning. Results: Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work-related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline. Conclusions: Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade. Design Prospective cohort study of office based British civil servants (1985-2004). Participants 10 308 men and women aged 35-55 at baseline, employed in 20 London civil service departments (the Whitehall II study); follow-up was an average of 18 years. Main outcome measures Physical component and mental component scores on SR-36 measured on five occasions. Results Physical health deteriorated more rapidly with age among men and women from the lower occupational grades. The average gap in physical component scores between a high and low grade civil servant at age 56 was 1.60 and this gap increased by 1 over 20 years. The average physical health of a 70 year old man or woman who was in a high grade position was similar to the physical health of a person from a low grade around eight Years younger. In mid-life, this gap was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades. Conclusions Social inequalities in self reported health increase in early old age. People from lower occupational grades age faster in terms of a quicker deterioration in physical health compared with people from higher grades. This widening gap suggests that health inequalities will become an increasingly important public health issue, especially as the population ages. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the determinants of self rated health (SRH) in men and women in the British Whitehall II study and the French Gazel cohort study. Methods: The cross sectional analyses reported in this paper use data from wave 1 of the Whitehall II study (1985-88) and wave 2 of the Gazel study (1990). Determinants were either self reported or obtained through medical screening and employer's records. The Whitehall II study is based on 20 civil service departments located in London. The Gazel study is based on employees of France's national gas and electricity company (EDF-GDF). SRH data were available on 6889 men and 3403 women in Whitehall II and 13 008 men and 4688 women in Gazel. Results: Correlation analysis was used to identify determinants of SRH from 35 measures in Whitehall II and 33 in Gazel. Stepwise multiple regressions identified five determinants (symptom score, sickness absence, longstanding illness, minor psychiatric morbidity, number of recurring health problems) in Whitehall II, explaining 34.7% of the variance in SRH. In Gazel, four measures (physical tiredness, number of health problems in the past year, physical mobility, number of prescription drugs used) explained 41.4% of the variance in SRH. Conclusion: Measures of mental and physical health status contribute most to the SRH construct. The part played by age, early life factors, family history, sociodemographic variables, psychosocial factors, and health behaviours in these two occupational cohorts is modest. [ABSTRACT FROM AUTHOR]

To investigate the association between stress at work and the metabolic syndrome. Design Prospective cohort study investigating the association between work stress and the metabolic syndrome. Participants 10 308 men and women, aged 35-55, employed in 20 London civil service departments at baseline (the Whitehall II study); follow-up was an average of 14 years. Main outcome measures Work stress based on the iso-strain model, measured on four occasions (1985-99). Biological measures of the metabolic syndrome, based on the National Cholesterol Education Program definition, measured in 1997-9. Results A dose-response relation was found between exposure to work stressors over 14 years and risk of the metabolic syndrome, independent of other relevant risk factors. Employees with chronic work stress (three or more exposures) were more than twice as likely to have the syndrome than those without work stress (odds ratio adjusted for age and employment grade 2.25, 95% confidence interval 1.31 to 3.85). Conclusions Stress at work is an important risk factor for the metabolic syndrome. The study provides evidence for the biological plausibility of the link between psychosocial stressors from everyday life and heart disease. [ABSTRACT FROM AUTHOR]

Objectives: To study the influence of change in self perceived psychosocial work characteristics on subsequent rates of sickness absence. Methods: Prospective cohort study of British civil service employees. Job control, lob demands, and work social supports were measured in 1985/88 and in 1991/93. Analyses included 3817 British civil servants with sickness absence records at baseline (1985-89) and for two follow up periods, early (1994-95) and later follow up (1996-98). Results: Change in work characteristics predicted subsequent incidence of long spells of sickness absence (>7 days) in the early follow up period after adjustment for covariates including baseline work characteristics, health status, and sickness absence. Adjusted rate ratios were 1.23 (95% CI 1.03 to 1.46) for decreased compared with stable decision latitude; 1.17 (95% Cl 1.01 to 1.36) for increased compared with stable job demands and 0.79 (95% CI 0.67 to 0.93) for increased compared with stable work social support. These associations were also seen in a sub-sample who did not change employment grade. In the later follow up period, associations between work change and long spells of sickness absence were similar for decision latitude, less pronounced for lob demands, and no longer apparent for social supports. Changes in work characteristics were not associated with subsequent short spells of sickness absence (⩽ 7 days). Conclusions: Adverse changes in the psychosocial work environment may lead to increased rates of sickness absence. These findings suggest that workplace interventions to improve psychosocial working conditions may reduce levels of sickness absence. [ABSTRACT FROM AUTHOR]