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Diabetologia

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01.11.2008 | Article

Biological and behavioural explanations of social inequalities in coronary heart disease: the Whitehall II study

verfasst von: M. G. Marmot, M. J. Shipley, H. Hemingway, J. Head, E. J. Brunner

Erschienen in: Diabetologia | Ausgabe 11/2008

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Abstract

Aims/hypothesis

We determined the degree to which metabolic syndrome components, inflammation and health behaviours account for the social gradient in CHD.

Methods

A total of 5312 men, initially aged 39 to 63 years, were followed for 13.1 years for incident coronary death or non-fatal myocardial infarction according to socioeconomic position (employment grade). The contribution of explanatory factors to socioeconomic differences in CHD was assessed by the reduction in hazard ratios computed using Cox models. The effects of measurement error were taken into account.

Results

Coronary events were more common in lower employment grades than in higher, with a hazard ratio (relative index of inequality) of 2.2 (95% CI 1.3–3.7), after adjustment for age and ethnic group. Behavioural risk factors (mainly smoking and diet) explained a third of the socioeconomic gradient in CHD incidence. Components of the metabolic syndrome and inflammatory markers predicted CHD incidence and also explained a third of the gradient. Combined, these two groups of predictors, i.e. behavioural and biological, accounted for over half of the socioeconomic gradient in incident CHD. Adding body height as a marker of the effects of early life increased this figure to about 60%.

Conclusions/interpretation

A major question has been how someone’s socioeconomic position can lead to increased risk of CHD. Socioeconomic differences in components of the metabolic syndrome (and inflammatory markers) provide part of the answer. This was, to an important degree, independent of the contribution of health behaviours to the socioeconomic differentials in CHD.

Drever F, Whitehead M (1997) Health inequalities: decennial supplement. Series DS No. 15 Stationery Office, Office for National Statistics, London, pp 1–257

No authors listed (1998) Health, United States, 1998 socioeconomic status and health chartbook. US Department of Health and Human Services

Marmot MG, Shipley MJ, Rose G (1984) Inequalities in death—specific explanations of a general pattern. Lancet 323:1003–1006CrossRef

Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S (1997) Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet 350:235–239PubMedCrossRef

Lynch JW, Kaplan GA, Cohen RD, Tuomilehto J, Salonen JT (1996) Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol 144:934–942PubMed

Kunst AE, Groenhof F, Mackenbach JP, The EU Working Group on Socioeconomic Inequalities in Health (1998) Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. BMJ 316:1636–1638PubMed

Diez Roux AV, Merkin SS, Arnett D et al (2001) Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 345:99–106PubMedCrossRef

Adler N, Ostrove J (1999) Socioeconomic status and health: What we know and what we don’t. In: Adler N, Marmot M, McEwen B, Stewart J (eds) Socioeconomic status and health in industrial nations. New York Academy of Sciences, New York, pp 3–15

van Rossum CTM, Shipley MJ, Van de Mheen H, Grobbee DE, Marmot MG (2000) Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health 54:178–184PubMedCrossRef

10.

Emberson JR, Whincup PH, Morris RW, Walker M (2004) Social class differences in coronary heart disease in middle-aged British men: implications for prevention. Int J Epidemiol 33:289–296PubMedCrossRef

11.

Sundstrom J, Riserus U, Byberg L, Zethelius B, Lithell H, Lind L (2006) Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. BMJ 332:878–882PubMedCrossRef

12.

Brunner EJ, Marmot MG, Nanchahal K et al (1997) Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study. Diabetologia 40:1341–1349PubMedCrossRef

13.

Gimeno D, Brunner EJ, Lowe GDO, Rumley A, Marmot MG, Ferrie JE (2007) Adult socioeconomic position, C-reactive protein and interleukin-6 in the Whitehall II prospective study. Eur J Epidemiol 22:677–683CrossRef

14.

Marmot MG, Davey Smith G, Stansfeld SA et al (1991) Health inequalities among British Civil Servants: the Whitehall II study. Lancet 337:1387–1393PubMedCrossRef

15.

Marmot MG, Brunner EJ (2005) Cohort profile: the Whitehall II study. Int J Epidemiol 34:251–256PubMedCrossRef

16.

Brunner EJ, Stallone D, Juneja M, Bingham S, Marmot M (2001) Dietary assessment in Whitehall II: comparison of 7d diet diary and food frequency questionnaire and validity against biomarkers. Br J Nutr 86:405–414PubMedCrossRef

17.

Martikainen P, Brunner E, Marmot M (2003) Socioeconomic differences in dietary patterns among middle-aged men and women. Soc Sci Med 56:1397–1410PubMedCrossRef

18.

Brunner EJ (1997) Socioeconomic determinants of health: stress and the biology of inequality. BMJ 314:1472–1476PubMed

19.

World Health Organization (1977) International classification of diseases—9th revision. World Health Organization, Geneva

20.

Rose G, Hamilton PJS, Colwell L, Shipley MJ (1982) A randomised controlled trial of anti-smoking advice: 10-year results. J Epidemiol Community Health 36:102–108PubMed

21.

Macfarlane PW, Devine PW, Latif S, McLaughlin S, Shoat DB, Watts MP (1990) Methodology of ECG interpretation in the Glasgow program. Methods Inform Med 29:354–361

22.

Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A (1994) Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90:583–612PubMed

23.

Kunst AE, Mackenbach JP (1994) The size of mortality differences associated with educational level in nine industrialized countries. Am J Public Health 84:932–937PubMed

24.

Sergeant JC, Firth D (2006) Relative index of inequality: definition, estimation, and inference. Biostatistics 7:213–224PubMedCrossRef

25.

Hardin JW, Schmiediche H, Carroll RJ (2003) The regression calibration method for fitting generalized linear models with additive measurement error. The Stata Journal 8:361–372

26.

Davey Smith G, Lynch J (2004) Life course approaches to socioeconomic differentials in health. In: Kuh D, Ben Shlomo Y (eds) A life course approach to chronic disease epidemiology. 2nd edn. OUP, Oxford, pp 77–115

27.

Kumari M, Marmot M, Brunner E (2000) Social determinants of von Willebrand factor: the Whitehall II study. Arterioscler Thromb Vasc Biol 20:1842–1847PubMed

28.

Brunner EJ, Davey Smith G, Marmot MG, Canner R, Beksinska M, O'Brien J (1996) Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen. Lancet 347:1008–1013PubMedCrossRef

29.

Danesh J, Wheeler JG, Hirschfield GM et al (2004) C-Reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med 350:1387–1397PubMedCrossRef

30.

Timpson NJ, Lawlor DA, Harbord RM et al (2005) C-reactive protein and its role in metabolic syndrome: Mendelian randomisation study. Lancet 366:1954–1959PubMedCrossRef

31.

Casas JP, Shah T, Cooper J et al (2006) Insight into the nature of the CRP-coronary event association using Mendelian randomization. Int J Epidemiol 35:922–931PubMedCrossRef

32.

Stephens JW, Hurel SJ, Lowe GD, Rumley A, Humphries SE (2007) Association between plasma IL-6, the IL6-174G>C gene variant and the metabolic syndrome in type 2 diabetes mellitus. Mol Genet Metab 90:422–428PubMedCrossRef

33.

Brunner EJ, Mosdol A, Witte DR, Martikainen P, Shipley MJ, Marmot MG (2008) Dietary patterns, mortality and chronic disease risk in the Whitehall II study over 13 years of follow up. Am J Clin Nutr 87:1414–1421PubMed

34.

Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J (1998) Socioeconomic factors, health behaviors, and mortality. JAMA 279:1703–1708PubMedCrossRef

35.

Rennie KL, McCarthy N, Yazdgerdi S, Marmot M, Brunner E (2003) Association of the metabolic syndrome with both vigorous and moderate physical activity. Int J Epidemiol 53:600–606CrossRef

36.

Tuomilehto J, Lindstrom J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350PubMedCrossRef

37.

Barker DJP (1994) Mothers, babies, and disease in later life. BMJ, London

38.

McCarron P, Okasha M, McEwen J, Davey Smith G (2002) Height in young adulthood and risk of death from cardiorespiratory disease: a prospective study of male former students of Glasgow University, Scotland. Am J Epidemiol 155:683–687PubMedCrossRef

39.

Marmot MG (1997) Early life and adult disorder: research themes. Br Med Bull 53:3–9PubMed

40.

Rosmond R, Bjorntorp P (2000) The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 247:188–197PubMedCrossRef

41.

Brunner EJ, Hemingway H, Walker BR et al (2002) Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome. Circulation 106:2659–2665PubMedCrossRef

42.

Hemingway H, Shipley M, Brunner E, Britton A, Malik M, Marmot MG (2005) Does autonomic function link social position to coronary risk? The Whitehall II Study. Circulation 111:3071–3077PubMedCrossRef

43.

Kuper H, Marmot M (2003) Job strain, job demands, decision latitude, and the risk of coronary heart disease within the Whitehall II study. J Epidemiol Community Health 57:147–153PubMedCrossRef

44.

Chandola T, Brunner E, Marmot M (2006) Chronic stress at work and the metabolic syndrome: prospective study. BMJ 332:521–525PubMedCrossRef

45.

Brunner EJ, Chandola T, Marmot MG (2007) Prospective effect of job strain on general and central obesity in the Whitehall II Study. Am J Epidemiol 165:828–837PubMedCrossRef

46.

Wamala SP, Mittleman MA, Schenck-Gustafsson K, Orth-Gomer K (1999) Potential explanations for the educational gradient in coronary heart disease: a population-based case-control study of Swedish women. Am J Public Health 89:315–321PubMedCrossRef

47.

Davey-Smith G, Neaton JD, Wentworth D, Stamler R, Stamler J (1996) Socioeconomic differentials in mortality risk among men screened for the multiple risk factor intervention trial: I. White men. Am J Public Health 86:486–496

48.

Pearce N, Pomare E, Marshall S, Borman B (1993) Mortality and social class in Maori and non Maori New Zealand men: changes between 1975–7 and 1985–7. N Z Med J 106:193–196PubMed

49.

Siannis F, Farewell VT, Head J (2007) A multi-state model for joint modelling of terminal and non-terminal events with application to Whitehall II. Stat Med 26:426–442PubMedCrossRef

50.

Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P (2007) Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 335:136PubMedCrossRef

Titel: Biological and behavioural explanations of social inequalities in coronary heart disease: the Whitehall II study
verfasst von: M. G. Marmot
M. J. Shipley
H. Hemingway
J. Head
E. J. Brunner
Publikationsdatum: 01.11.2008
Verlag: Springer-Verlag
Erschienen in: Diabetologia / Ausgabe 11/2008
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-008-1144-3

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Abstract

Aims/hypothesis

Methods

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