DOCSLIB.ORG

Overweight and Stroke in the Whitehall Study J Epidemiol Community Health: First Published As 10.1136/Jech.45.2.138 on 1 June 1991

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Overweight and Stroke in the Whitehall Study J Epidemiol Community Health: First Published As 10.1136/Jech.45.2.138 on 1 June 1991 Jrournal of Epidemiology and Community Health 1991; 45: 138-142 Overweight and stroke in the Whitehall Study J Epidemiol Community Health: first published as 10.1136/jech.45.2.138 on 1 June 1991. Downloaded from Roger Shinton, Martin Shipley, Geoffrey Rose Abstract overweight itself, adjustment for variables which Study objective-The aim was to examine are also likely mechanisms (for example, the risk of increasing overweight for death hypertension) may be misleading.6 Some doubt, from stroke. furthermore, has recently been cast on the Design-This was a prospective cohort interpretation of the results of statistical models study, in which the main outcome measure which do not reflect the biological interactions of was the mortality ratio for stroke with the risk factors under consideration.7 8 For these increasing body mass index. reasons an analysis avoiding both inappropriate Setting-Civil service departments, adjustments and statistical modelling seemed Whitehall, London. worthwhile. The study will, however, take Subjects-Participants were 17 753 men account of cigarette smoking, both because of its aged 40 to 64 years. complex relation to obesity and stroke,9 and Measurements and main results-208 because overweight and cigarette smoking are stroke deaths were recorded. Men aged 40 to particularly relevant to intervention since they 54 in the most overweight quintile of body can be easily identified without reference to mass index had a mortality ratio of 2-01 medical practitioners. (95% confidence interval 0 9 to 4'7) The straightforward analysis of risk factors in compared to the thinnest quintile. The clusters does require large case numbers. The mortality ratio was 1 19 (95% CI 0 7 to 2 0) in cohort of Whitehall civil servantsl' now enables men aged 55 to 64. The increase in risk was assessment of the risk of overweight and its more apparent in non-smokers: age relationship to cigarette smoking for a substantial number of stroke deaths. adjusted mortality ratio 2 58 (95% CI 1-2 to 5 7). When smoking status and overweight were considered in combination a gradient Methods of the age adjusted mortality ratio was Details of the Whitehall study have been observed, from 10 in thinner/non-smokers published5 10; 18 403 male civil servants aged up to 3-15 in fatter/current smokers. On the 40-64 years were examined between 1967 and assumption that smoking and obesity cause 1969 and their records flagged at the National strokes, an estimated 60% of strokes could Health Service Central Registry. http://jech.bmj.com/ be prevented if these two easily identifiable A selfadministered questionnaire, completed at risk factors could be avoided. the screening examination, included details of Conclusions-The risks of overweight for cigarette smoking. For the present analysis death from stroke were more apparent in subjects were divided into non-smokers, ex- younger subjects and non-smokers. A cigarette smokers, current cigarette smokers, and substantial proportion of stroke deaths others (non-responders; pipe or cigar smokers). occurring under the age of 80 years would The latter group was excluded, leaving a total of probably be prevented if cigarette smoking 17 753 men on which to base this analysis. on September 26, 2021 by guest. Protected copyright. Department of and overweight could be avoided. Subjects were weighed in light clothing and had Medicine, University their height measured with their shoes removed. of Birmingham, Body mass index (weight in kg [height in Dudley Road Although there is good evidence that Hospital, overweight metres]2) was grouped into quintiles.5 Birmingham and blood pressure are causally related, the role of Mortality data were available until 31st January B18 7QH, overweight in stroke has been less clear. 1985, providing a minimum of 15 years of follow United Kingdom Overweight might cause strokes through the R Shinton up. Total person-years at risk during the follow Department of mechanism of high blood pressure, diabetes, and up period were cross tabulated by smoking status, Epidemiology and raised blood lipids, but a clear association has not body mass index quintile, and five year age group. Population Sciences, been described.1-3 Data from the Framingham Stroke deaths were defined as those where stroke London School of that itself Hygiene and Tropical study have, however, suggested obesity (International Classification of Diseases, 8th Medicine, Keppel St, does carry a significantly increased risk of stroke.4 Revision, 430-438) was certified as the underlying London WC1 Some confusion about the risk of overweight cause. This included cerebral infarct and M Shipley for stroke may have arisen because ofthe cerebral and subarachnoid G Rose tendency thrombosis, in recent years to make multiple adjustments for a haemorrhage, and stroke of uncertain pathology. Correspondence to: large number of interdependent risk factors. In a Narrow age strata, each with sufficient case Dr Shinton at 24 Belle Vue of the Whitehall cohort which numbers, are to examine the Terrace, Hampton-in- previous analysis ideally required Arden, Solihull, West was primarily concerned with glycaemia, a possible confounding or interaction of age on the Midlands B92 OAR, UK multiple logistic regression coefficient suggesting relation between overweight and stroke. The data into two Accepted for publication a non-significant protective effect of overweight were, therefore, stratified age groups July 1990 for stroke was obtained.5 To examine the risks of (40-54 and 55-64 years) for presentation. Overweight and stroke in the Whitehall Study 139 Confidence intervals for unadjusted rate ratios (95% CI 0-8 to 2-0), while that for current J Epidemiol Community Health: first published as 10.1136/jech.45.2.138 on 1 June 1991. Downloaded from were obtained by first calculating the confidence smokers was 1 66 (95% CI 1-1 to 2t6). interval for the ratio ofthe stroke deaths using the Because smokers are at increased risk of stroke binomial distribution and then dividing these by and also tend to be thinner, the risk ofoverweight the ratio of the person-years. Age adjusted rate for death from stroke was examined in the ratios were calculated as the ratio of directly different smoking categories. Figure 2 and table standardised rates. These age standardised rates II suggest that the risk gradient (but not the actual were obtained using the total Whitehall study rate) is greater in those who never smoked. population as standard. Confidence intervals for Confidence intervals, however, are wide. these adjusted rate ratios were calculated.'l In order to assess the risks for death from Attributable risks were calculated by first stroke of different overweight/smoking status estimating the expected strokes in each of two age combinations, the lower two and upper three groups (40-54 and 55-64 years) if the baseline quintiles of body mass index were each grouped rates had applied to the whole group; the together. As age is associated with both stroke risk difference between the expected and observed numbers estimates the avoidable stroke deaths in 0 2.0- o each age group. These were then added together. 0 0 0 m 1.5- 0 Results 0 After 15 years of follow up 3427 men had died. 0 Two hundred and eight deaths (6 1%) were ' 1.0 o 40-54 years| * 55-64 years attributed to stroke and 1352 (39-5%) to coronary 'o0 heart disease. A further seven strokes were in the pipe/cigar/non-responder group. Of the 208 0E 0.5- stroke deaths, 26 were attributed to subarachnoid 010. haemorrhage (ICD 430) and 42 to intracerebral 2 haemorrhage (ICD 431). At screening 43% (7601) of the men were 0 -22.4 -24.0 -25.4 -27.0 >27.0 current smokers, 38% (6697) ex-smokers, and Quintile of body mass index (kg/m2 19% (3455) had never smoked. The variation in mortality rates by quintile of Figure I Stroke mortality rate by quintile of body mass body mass index in the two age groups is shown in index in men aged 40 to 54 years and 55 to 64 years. fig 1. Table I provides the mortality rate ratios relative to the thinnest quintile and suggests there 1.41 Non-smokers may be differences between the two age groups. Ex-smokers cti E Current smokers However, mortality ratios for all ages have been 1. 1.2H presented both with and without age adjustment. o -.... Failure to adjust for age could overestimate the 0 1.0- in body 0 risks of overweight as there is a small rise 0 mass index with age-19% of men aged 40-54 C°, Q8- http://jech.bmj.com/ years were in the highest quintile of body mass 0 index compared to 22% ofmen aged 55-64 years. c 0.6- Conversely, age adjustment could obscure risks if X 0.4- part of the added risk of advancing age is due to 0 the increasingly long exposure to being 0 2 0.2- overweight. The data suggest a steady rise in the 635 hazards ofoverweight in men under 55 years but a 0- -22.4 -24.0 -25.4 -270 .>27.0 U shaped curve in the older age group. Overall, on September 26, 2021 by guest. Protected copyright. obesity appears to carry increased risk of stroke. Quintile of body mass index (kg/mr2) The age adjusted stroke mortality rate ratio for Figure 2 Stroke mortality rate by quintile of body ex-smokers compared with non-smokers was 1-25 mass index in the different smoking status groups. Table I Stroke mortality rate ratio by Body mass index quintile (kg/m2) quintile of body mass -27-0 >27-0 index -22-4 -24-0 -25-4 40-54 Years Person-years at risk 39 048 37 265 37 436 33 371 33 578 No of stroke deaths 11 14 13 13 19 Rate ratio (1 0) 1 33 1-23 1 38 2-01 (95% confidence interval) (0-9 to 4-7) 55-64 Years Person-years at risk 17 127 15 629 16 874 17 404 18 984 No of stroke deaths 28 24 23 26 37 Rate ratio (1 0) 0-94 0-83 0 91 1.19 (95% confidence interval) (0-7 to 2-0) All ages Person-years at risk 56 175 52 894 54 310 50 775 52 562 No of stroke deaths 39 38 36 39 56 Rate ratio (1-0) 1-03 0-95 1-11 1-53 (95% confidence interval) (1-0 to 2-4) Age adjusted rate ratio (1-0) 1-01 0-89 0-97 1-30 (95% confidence interval) (0-9 to 2-0) 140 Roger Shinton, Martin Shipley, Geoffrey Rose and smoking status, the results have been smoking and overweight directly cause strokes J Epidemiol Community Health: first published as 10.1136/jech.45.2.138 on 1 June 1991.
Load more

Recommended publications
  • 1/11/2006 Health in an Unequal World Michael Marmot This Is a Lightly
    1/11/2006 Health in an Unequal World Michael Marmot This is a lightly edited version of the (October) 2006 Harveian Oration at the Royal College of Physicians. It will be published in Clinical Medicine and the Lancet. In poor countries, tragically, people die unnecessarily. In rich countries, too, the higher death rate of those in less fortunate social positions is unnecessary. Can there be a link between these two phenomena: inequalities in health among countries and inequalities within? Surely, it might be argued, the depredations of grinding poverty – lack of food, shelter, clean water, and basic medical care or public health – that ravage the lives of the poor in developing countries are different in kind from the way that social disadvantage leads to poor health in modern Britain, for example. The diseases of the slums of Nairobi are, to be sure, different in kind from the diseases that affect the disadvantaged in east London or Harlem, and have different proximate causes. There is, however, a link. The unnecessary disease and suffering of the disadvantaged, whether in poor countries or rich, is a result of the way we organise our affairs in society. I shall argue, in this oration, that failing to meet the fundamental human need of autonomy, empowerment, or human freedom is a potent cause of ill-health. In making this case, I shall bring together two rather disparate streams of work. The first is a report of my own research endeavour. I have sought explanations for the social gradient in health, as observed in the Whitehall studies, pointing to the fundamental importance of the circumstances in which people live and work.
    [Show full text]
  • Obesity and Overweight in Relation to Mortality in Men with and Without Type 2 Diabetes/Impaired Glucose Tolerance the Original Whitehall Study
    Cardiovascular and Metabolic Risk BRIEF REPORT Obesity and Overweight in Relation to Mortality in Men With and Without Type 2 Diabetes/Impaired Glucose Tolerance The original Whitehall Study 1 2 G. DAVID BATTY, PHD MICHAEL G. MARMOT, FRCP IGT (n ϭ 1,030) and in those with type 2 2 2 MIKA KIVIMAKI, PHD MARTIN J. SHIPLEY, MSC diabetes (n ϭ 195) was very similar. That 3 GEORGE DAVEY SMITH, MD is, there was no suggestion that the all- cause weight-mortality relation differed between the IGT (hazard ratio [HR] per n studies of apparently healthy individ- ernment employees aged 40–69 years increase in weight category 1.12 [95% CI uals, overweight and obesity, typically when examined between 1967 and 1970, 1.00–1.25]) and diabetes group (1.19 I assessed using BMI, have been consis- representing a 74% response (22). Height [0.94–1.49], P ϭ 0.64 for difference in tently associated with an increased risk of and weight were measured using stan- gradient between groups). Similar results all-cause mortality, cardiovascular dis- dard protocols, and BMI was computed were apparent when CVD was the out- ease (CVD), and select cancers (1–4). (weight [kg]/height2 [m2]) and catego- come of interest (P ϭ 0.98). Therefore, we However, extrapolating these results to rized according to current guidelines combined the IGT and type 2 diabetes individuals with type 2 diabetes is com- (23): normal weight (18.5 to Ͻ25.0), groups, an approach we have taken else- plex and perhaps inappropriate. Studies over weight (25.0–29.99), and obesity where (26).
    [Show full text]
  • (Non-Insulin-Dependent) Diabetes Mellitus and Cardiovascular Disease - Putative Association Via Common Antecedents; Further Evidence from the Whitehall Study
    Diabetologia (1988) 31:737-740 Diabetologia Springer-Verlag 1988 Type 2 (non-insulin-dependent) diabetes mellitus and cardiovascular disease - putative association via common antecedents; further evidence from the Whitehall Study R. J. Jarrett t and M.J. Shipley 2 1 Division of Community Health, United Medical and Dental Schools of Guy's and St. Thomas's Hospitals (Guy's Campus), and 2 Division of Medical Statistics and Epidemiology, London School of Hygiene and Tropical Medicine, U.K. Summary. Fifteen year mortality rates are reported for men creasing duration of diabetes. With adjustment for other risk participating in the Whitehall Study in 1968-70. Subjects factors, relative risks were similar in newly diagnosed and were divided into four groups - normoglycaemic (centiles previously diagnosed diabetic men. There was no significant 1-95 of the blood glucose distribution: n=17,05t), glucose linear trend of adjusted relative risks with duration of diabe- intolerant (centiles96-100: n=999), newly diagnosed dia- tes when all diabetic men were pooled and person years at betic patients (n= 56) and previously diagnosed diabetic pa- risk calculated. The lack of effect of duration upon relative tients (n= 121) treated with diet + tablets. Relative risks for risk together with other observations suggests common, pos- all causes mortality- and from coronary and cardiovascular sibly genetic, antecedents of both Type 2 (non-insulin-de- disease deaths were calculated. Age adjusted relative risks pendent) diabetes and coronary heart disease. were highest in the newly diagnosed diabetic patients and were also increased in glucose intolerant and previously di- Key words: Type 2 (non-insulin-dependent)diabetes mellitus, agnosed diabetic men (p< 0.05), but did not increase with in- diabetes duration, cardiovascular disease mortality.
    [Show full text]
  • The Whitehall Studies and Health Inequalities, 1968 to C.2010 Peder Clark
    CONTEMPORARY BRITISH HISTORY https://doi.org/10.1080/13619462.2020.1856082 ‘What else can you expect from class-ridden Britain?’: the Whitehall studies and health inequalities, 1968 to c.2010 Peder Clark Centre for the Social History of Health & Healthcare, University of Strathclyde, Glasgow, UK ABSTRACT KEYWORDS The Whitehall studies of British civil servants, running from 1968 Health inequalities; until the present day, are some of the most influential in twentieth Whitehall studies; class; century public health. Believing that the stratification that they stress; heart disease observed among civil servants was replicated in wider society through the class system, the Whitehall researchers argued that inequality was a powerful force in society, literally embodied by incidence of disease. But as politicians and sociologists questioned the continuing relevance of class, this article explores how these studies reflected and were in conversation with prevailing social attitudes about inequality in end-of-century Britain. Introduction In 1996, The Great Leveller, a documentary screened on Channel 4, opened with Richard Campbell, a 43-year-old fire safety inspector at the Home Office, describing his recent and sudden heart attack. ‘Until then, like most of us’, the narrator intoned, ‘he thought that his health depended mainly on diet, exercise and smoking’. Setting up the rest of the programme, which would explore epidemiological research conducted on civil servants such as Campbell, the narrator rhetorically asked ‘But is that true?’ before replying: ‘Some scientists now think it isn’t’. Campbell’s health scare was contrasted with the happy old age of another Richard; Sir Richard Way, at 83, a former permanent secretary in the Ministry of Aviation, and apparently, ‘as fit as a fiddle’.
    [Show full text]
  • Whitehall Booklet
    the Whitehall II study WORK STRESS AND HEALTH: the Whitehall II study Published by Public and Commercial Services Union on behalf of Council of Civil Service Unions/Cabinet Office, CCSU: 160 Falcon Road, London SW11 2LN, Tel: 020 7223 8340, Fax: 020 7223 8363, Email: [email protected] Secretary: Charles Cochrane Cabinet office: Corporate Development Division, Cabinet Office, Admiralty Arch, The Mall, London, SW1A 2WH Copyright © 2004 CCSU/Cabinet Office Editor Dr Jane E. Ferrie Contributors Dr Ruth Bell Dr Annie Britton Dr Eric Brunner Dr Tarani Chandola Dr Jane Ferrie Ms Miriam Harris Ms Jenny Head Professor Sir Michael Marmot Ms Gill Mein Dr Mai Stafford International Centre for Health and Society/Department of Epidemiology and Public Health, University College London, UK Website: www.ucl.ac.uk/WhitehallII Telephone: +44(0)207 679 5937 WORK, STRESS AND HEALTH: the Whitehall II study Contents Foreword 2 Introduction 3 The Whitehall II study 3 The Social Gradient 4 Demands and control at work 6 Social support at work 8 Effort-reward imbalance at work 10 Job insecurity 12 Organisational change 14 Health behaviour 16 Social support outside work 18 The Work-home interface 20 Retirement 22 Summary 24 Foreword Joint CCSU/Cabinet Office laypersons’ guide to the Whitehall II research People are the Civil Service’s greatest resource and biggest asset. II studies. The team has published numerous academic papers, Their health and well being is of paramount importance to civil which provide deep insights into the underlying causes of ill servants themselves, their families, employing departments, health amongst civil servants.
    [Show full text]
  • Health Impact of Psychosocial Hazards at Work: an Overview
    Health Impact of Psychosocial Hazards at Work: An Overview Health Impact of Psychosocial Hazards at Work: An Overview Stavroula Leka BA MSc PhD CPsychol FRSPH Aditya Jain BA(H) MSc MA FRSPH Institute of Work, Health & Organisations, University of Nottingham Design & Layout: Philippos Yiannikouris WHO Library Cataloguing-in-Publication Data Health impact of psychosocial hazards at work: an overview / Stavroula Leka, Aditya Jain 1.Occupational health. 2.Risk management. 3.Workplace. 4.Psychology, Social. 5.Stress. 6.Risk assessment. I.Leka, Stavroula. II.Jain, A. III:World Health Organization. ISBN 978 92 4 150027 2 (NLM classification: WA 400) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Psychosocial Stress at Work and Cardiovascular Diseases: an Overview of Systematic Reviews
    Int Arch Occup Environ Health DOI 10.1007/s00420-015-1019-0 REVIEW ARTICLE Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews Alba Fishta · Eva-Maria Backé Received: 8 August 2014 / Accepted: 8 January 2015 © The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Conclusions Same to a SRev, an overview of SRev is Purpose Based on information reported in systematic used to summarize literature and identify areas in which reviews (SRevs), this study aimed to find out whether psy- research is needed. This overview can be used to: (a) Dis- chosocial stress at work leads to cardiovascular (CV) mor- seminate an up-to-date information on work-related stress bidity and mortality. as a risk factors for CV morbidity and mortality to gov- Methods A systematic search in PubMed and EMBASE ernment, health care providers, workers, and other stake- (until 2014) used a string based on PICOS components. holders; (b) Encourage governments to better regulate the A manual search was followed. Applying the predefined working conditions and consider work-related psychosocial criteria, two reviewers independently screened the titles, stress as a hazardous factor that leads to CV diseases or abstracts, selected full texts, and validated their qual- mortality; and (c) Analyze gaps in the literature and pro- ity. Discrepancies were resolved by discussion between vide a summary of research needs. reviewers. Studies of low quality were excluded. Contents of enrolled SRevs were extracted by one reviewer; a second Keywords Systematic reviews · Work-related reviewer evaluated their accurateness. psychosocial stress · Job strain · Cardiovascular diseases · Results The search resulted in 462 records.
    [Show full text]
  • The First Whitehall Study Mortality. a 25 Year Follow up of Civil Servants From
    Downloaded from jech.bmj.com on 4 December 2006 Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study Caroline T M van Rossum, Martin J Shipley, Hendrike van de Mheen, Diederick E Grobbee and Michael G Marmot J. Epidemiol. Community Health 2000;54;178-184 doi:10.1136/jech.54.3.178 Updated information and services can be found at: http://jech.bmj.com/cgi/content/full/54/3/178 These include: References This article cites 16 articles, 9 of which can be accessed free at: http://jech.bmj.com/cgi/content/full/54/3/178#BIBL 20 online articles that cite this article can be accessed at: http://jech.bmj.com/cgi/content/full/54/3/178#otherarticles Rapid responses You can respond to this article at: http://jech.bmj.com/cgi/eletter-submit/54/3/178 Email alerting Receive free email alerts when new articles cite this article - sign up in the box at the service top right corner of the article Notes To order reprints of this article go to: http://www.bmjjournals.com/cgi/reprintform To subscribe to Journal of Epidemiology and Community Health go to: http://www.bmjjournals.com/subscriptions/ Downloaded from jech.bmj.com on 4 December 2006 178 J Epidemiol Community Health 2000;54:178–184 Employment grade diVerences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study CarolineTMvanRossum, Martin J Shipley, Hendrike van de Mheen, Diederick E Grobbee, Michael G Marmot Abstract of these risk factors on these employment Study objective—To test the hypothesis grade diVerences in mortality rates were also that the association between socioeco- investigated.
    [Show full text]
  • Association of Ideal Cardiovascular Health at Age 50 with Incidence Of
    RESEARCH Association of ideal cardiovascular health at age 50 with BMJ: first published as 10.1136/bmj.l4414 on 7 August 2019. Downloaded from incidence of dementia: 25 year follow-up of Whitehall II cohort study Séverine Sabia,1,2 Aurore Fayosse,1 Julien Dumurgier,1 3 Alexis Schnitzler,1 Jean-Philippe Empana,4 Klaus P Ebmeier,5 Aline Dugravot,1 Mika Kivimäki,2,6 Archana Singh-Manoux1,2 1Inserm U1153, ABSTRACT RESULTS Epidemiology of Ageing and OBJECTIVES 347 incident cases of dementia were recorded over Neurodegenerative diseases, To examine the association between the Life Simple 7 a median follow-up of 24.7 years. Compared with an Université de Paris, 75010 Paris, France cardiovascular health score at age 50 and incidence of incidence rate of dementia of 3.2 (95% confidence 2Department of Epidemiology dementia. interval 2.5 to 4.0) per 1000 person years among and Public Health, University DESIGN the group with poor cardiovascular health, the College London, London, UK absolute rate differences per 1000 person years 3 Prospective cohort study. Cognitive Neurology Center, were −1.5 (95% confidence interval −2.3 to −0.7) Lariboisière – Fernand Widal SETTING for the group with intermediate cardiovascular Hospital, AP-HP, Université Paris Civil service departments in London (Whitehall II Diderot, Sorbonne Paris Cité, health and −1.9 (−2.8 to −1.1) for the group with study; study inception 1985-88). Paris, France optimal cardiovascular health. Higher cardiovascular 4Inserm, U970, Integrative PARTICIPANTS health score was associated with a lower risk of Epidemiology of Cardiovascular 7899 participants with data on the cardiovascular dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point Disease, Paris Descartes health score at age 50.
    [Show full text]
  • Disease. Social Class and Coronary Heart
    Downloaded from heart.bmj.com on August 6, 2010 - Published by group.bmj.com Social class and coronary heart disease. G Rose and M G Marmot Br Heart J 1981 45: 13-19 doi: 10.1136/hrt.45.1.13 Updated information and services can be found at: http://heart.bmj.com/content/45/1/13 These include: References Article cited in: http://heart.bmj.com/content/45/1/13#related-urls Email alerting Receive free email alerts when new articles cite this service article. Sign up in the box at the top right corner of the online article. Notes To order reprints of this article go to: http://heart.bmj.com/cgi/reprintform To subscribe to British Heart Journal go to: http://heart.bmj.com/subscriptions Downloaded from heart.bmj.com on August 6, 2010 - Published by group.bmj.com Br Heart J 1981: 45: 13-9 Social class and coronary heart disease GEOFFREY ROSE, M G MARMOT* From the Department of Medical Statistics and Epidemiology, London School of Hygiene and Tropical Medicine, London SUMmARY Over the past 40 years in England and Wales the rise in mortality from coronary heart disease has continued unabated among working-class men, whereas among professional men the rate has changed little for the past 20 years. As a result it is now 26 per cent higher in social class V compared with social class I. The difference in women is larger (+152%), and it has been present for at least 40 years. The social class gradient for men was confirmed in a survey of 17 530 London civil servants aged between 40 and 64 (the Whitehall Study).
    [Show full text]
  • When Reciprocity Fails: Effort–Reward Imbalance in Relation to Coronary Heart Disease and Health Functioning Within the Whiteh
    777 ORIGINAL ARTICLE When reciprocity fails: effort–reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study H Kuper, A Singh-Manoux, J Siegrist, M Marmot ............................................................................................................................. Occup Environ Med 2002;59:777–784 Background: A deleterious psychosocial work environment, as defined by high efforts expended in relation to few rewards reaped, is hypothesised to increase the risk of future poor health outcomes. Aims: To test this hypothesis within a cohort of London based civil servants. Methods: Effort–reward imbalance (ERI) was measured among 6895 male and 3413 female civil servants aged 35–55 during the first phase of the Whitehall II study (1985–88). Participants were fol- See end of article for authors’ affiliations lowed until the end of phase 5 (1997–2000), with a mean length of follow up of 11 years. Baseline ....................... ERI was used to predict incident validated coronary heart disease (CHD) events during follow up and poor mental and physical functioning at phase 5. Correspondence to: Results: Dr H Kuper, International A high ratio of efforts in relation to rewards was related to an increased incidence of all CHD Centre for Health and (hazard ratio (HR) = 1.36, 95% CI 1.12 to 1.65) and fatal CHD/non-fatal myocardial infarction Society, Department of (HR = 1.28, 95% CI 0.89 to 1.84) during follow up, as well as poor physical (odds ratio (OR) = 1.47, Epidemiology and Public 95% CI 1.24 to 1.74) and mental (OR = 2.24, 95% CI 1.89 to 2.65) functioning at phase 5, net of Health, University College employment grade.
    [Show full text]
  • PAPER Obesity and Overweight in Relation to Organ-Specific Cancer Mortality in London (UK): Findings from the Original Whitehall Study
    International Journal of Obesity (2005) 29, 1267–1274 & 2005 Nature Publishing Group All rights reserved 0307-0565/05 $30.00 www.nature.com/ijo PAPER Obesity and overweight in relation to organ-specific cancer mortality in London (UK): findings from the original Whitehall study GD Batty1,2*, MJ Shipley3, RJ Jarrett4, E Breeze3, MG Marmot3 and G Davey Smith5 1MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, UK; 2Department of Psychology, University of Edinburgh, UK; 3Department of Epidemiology and Public Health, University College London, London, UK; 4Bishopsthorpe Road, London, UK; and 5Department of Social Medicine, University of Bristol, Bristol, UK OBJECTIVE: To examine the relation of obesity and overweight with organ-specific cancer mortality. METHODS: 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). RESULTS: 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. CONCLUSION: Avoidance of obesity and overweight in adult life may reduce the risk of developing some cancers. International Journal of Obesity (2005) 29, 1267–1274.
    [Show full text]