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Br Heart J. Jan 1981; 45(1): 13–19.
PMCID: PMC482483

Social class and coronary heart disease.


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 17530 London civil servants aged between 40 and 64 (the Whitehall Study). When men in the lowest employment grade were compared with those in the top (administrative) grade, the age-adjusted prevalence rate was 53 per cent higher for angina, 77 per cent higher for ischaemic-type electrocardiographic abnormalities, and 75 per cent higher for the prevalence of electrocardiographic abnormality among men with angina. At follow-up, the seven-and-a-half year coronary mortality was 3.6 times higher in the lowest than in the top grade. This social class difference was partly explained by known coronary risk factors: men in the lower grades smoked more and exercised less, they were shorter and more overweight, and they had higher blood pressures and lower levels of glucose tolerance. Most of the difference, however, remains unexplained. It seems that there are major risk factors yet to be identified, and that these may throw light on how it is possible for members of a highly-placed social group to have a relatively low risk of coronary heart disease.

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Selected References

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  • Marmot MG, Adelstein AM, Robinson N, Rose GA. Changing social-class distribution of heart disease. Br Med J. 1978 Oct 21;2(6145):1109–1112. [PMC free article] [PubMed]
  • Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med. 1977 Mar;31(1):42–48. [PMC free article] [PubMed]
  • Reid DD, Hamilton PJ, McCartney P, Rose G, Jarrett RJ, Keen H. Smoking and other risk factors for coronary heart-disease in British civil servants. Lancet. 1976 Nov 6;2(7993):979–984. [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]
  • Higenbottam T, Clark TJ, Shipley MJ, Rose G. Lung function and symptoms of cigarette smokers related to tar yield and number of cigarettes smoked. Lancet. 1980 Feb 23;1(8165):409–411. [PubMed]
  • Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. [PMC free article] [PubMed]
  • STAMLER J, LINDBERG HA, BERKSON DM, SHAFFER A, MILLER W, POINDEXTER A. Prevalence and incidence of coronary heart disease in strata of the labor force of a Chicago industrial corporation. J Chronic Dis. 1960 Apr;11:405–420. [PubMed]
  • Antonovsky A. Social class and the major cardiovascular diseases. J Chronic Dis. 1968 May;21(2):65–106. [PubMed]
  • Miller GJ, Miller NE. Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. Lancet. 1975 Jan 4;1(7897):16–19. [PubMed]
  • Meade TW, North WR, Chakrabarti R, Haines AP, Stirling Y. Population-based distributions of haemostatic variables. Br Med Bull. 1977 Sep;33(3):283–288. [PubMed]
  • Logan RL, Riemersma RA, Thomson M, Oliver MF, Olsson AG, Walldius G, Rössner S, Kaijser L, Callmer E, Carlson LA, et al. Risk factors for ischaemic heart-disease in normal men aged 40. Edinburgh-Stockholm Study. Lancet. 1978 May 6;1(8071):949–954. [PubMed]
  • Sinclair H. Dietary fats and coronary heart disease. Lancet. 1980 Feb 23;1(8165):414–415. [PubMed]
  • Morris JN, Marr JW, Clayton DG. Diet and heart: a postscript. Br Med J. 1977 Nov 19;2(6098):1307–1314. [PMC free article] [PubMed]

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