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J Epidemiol Community Health. Mar 2000; 54(3): 178–184.
PMCID: PMC1731642

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study

Abstract

STUDY OBJECTIVE—To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men.
DESIGN—25 year follow up of mortality in relation to employment grade.
SETTING—The first Whitehall study.
PARTICIPANTS—18 001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years.
MAIN OUTCOME MEASURE—Specific causes of death.
RESULTS—After more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases.
CONCLUSIONS—Differentials in mortality persist at older ages for almost all causes of death.


Keywords: mortality; socioeconomic factors; cause of death.

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Selected References

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  • Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. [PubMed]
  • Mackenbach JP. Socioeconomic inequalities in health in The Netherlands: impact of a five year research programme. BMJ. 1994 Dec 3;309(6967):1487–1491. [PMC free article] [PubMed]
  • Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. [PubMed]
  • Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978 Dec;32(4):244–249. [PMC free article] [PubMed]
  • Marmot MG, Shipley MJ, Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. [PubMed]
  • Smith GD, Shipley MJ, Rose G. Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study. J Epidemiol Community Health. 1990 Dec;44(4):265–270. [PMC free article] [PubMed]
  • Guralnik JM, Land KC, Blazer D, Fillenbaum GG, Branch LG. Educational status and active life expectancy among older blacks and whites. N Engl J Med. 1993 Jul 8;329(2):110–116. [PubMed]
  • Kaplan GA, Seeman TE, Cohen RD, Knudsen LP, Guralnik J. Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. Am J Public Health. 1987 Mar;77(3):307–312. [PMC free article] [PubMed]
  • Martelin T. Mortality by indicators of socioeconomic status among the Finnish elderly. Soc Sci Med. 1994 May;38(9):1257–1278. [PubMed]
  • Jefferys M. Social inequalities in health--do they diminish with age? Am J Public Health. 1996 Apr;86(4):474–475. [PMC free article] [PubMed]
  • Marmot MG, Shipley MJ. Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. BMJ. 1996 Nov 9;313(7066):1177–1180. [PMC free article] [PubMed]
  • Reid DD, Brett GZ, Hamilton PJ, Jarrett RJ, Keen H, Rose G. Cardiorespiratory disease and diabetes among middle-aged male Civil Servants. A study of screening and intervention. Lancet. 1974 Mar 23;1(7856):469–473. [PubMed]
  • Smith GD, Leon D, Shipley MJ, Rose G. Socioeconomic differentials in cancer among men. Int J Epidemiol. 1991 Jun;20(2):339–345. [PubMed]
  • Samphier ML, Robertson C, Bloor MJ. A possible artefactual component in specific cause mortality gradients. Social class variations in the clinical accuracy of death certificates. J Epidemiol Community Health. 1988 Jun;42(2):138–143. [PMC free article] [PubMed]
  • Shipley MJ, Pocock SJ, Marmot MG. Does plasma cholesterol concentration predict mortality from coronary heart disease in elderly people? 18 year follow up in Whitehall study. BMJ. 1991 Jul 13;303(6794):89–92. [PMC free article] [PubMed]
  • Marmot M, Theorell T. Social class and cardiovascular disease: the contribution of work. Int J Health Serv. 1988;18(4):659–674. [PubMed]
  • Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner E, Stansfeld SA. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ. 1997 Feb 22;314(7080):558–565. [PMC free article] [PubMed]
  • Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. [PubMed]
  • Hill P. It is not what you eat, but how you eat it digestion, life-style, nutrition. Nutrition. 1991 Nov-Dec;7(6):385–395. [PubMed]
  • House JS, Strecher V, Metzner HL, Robbins CA. Occupational stress and health among men and women in the Tecumseh Community Health Study. J Health Soc Behav. 1986 Mar;27(1):62–77. [PubMed]
  • Marmot MG, McDowall ME. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. [PubMed]

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