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Biomedical subjects

M G Marmot

Publications and source records attributed to M G Marmot.

At least 19 recordsLinked to original sources
PubMed1998

Explaining social class differences in depression and well-being.

Work characteristics, including skill discretion and decision authority, explain most of the socioeconomic status gradient in well-being and depression in middle-aged British civil servants from the Whitehall II Study, London. Social support explained about one-third of the gradient, life events and material difficulties less than one-third. Socioeconomic status was measured by employment grade. Work characteristics were based on the Karasek model, social support was measured by the Close Persons Questionnaire, depression by the General Health Questionnaire and well-being by the Affect Balance Scale. Despite a small contribution from social selective factors measured by upward mobility, the psychosocial work environment explained most of the cross-sectional socioeconomic status gradient in well-being and depression.

Adult↗
PubMed1998

The health effects of major organisational change and job insecurity.

Since August 1988 an increasing proportion of the executive functions of government in the United Kingdom have been devolved to executive agencies. Transfer to an executive agency involves a period of uncertainty during which the options of elimination or transfer to the private sector are considered, followed by a marked change in management style and further periods of uncertainty when the agency's function is reconsidered for transfer to the private sector. This paper examines the effects of this major organisational change and consequent job insecurity on the health status of a cohort of 7419 white-collar civil servants by comparing groups either exposed to or anticipating exposure to this stressor, with controls experiencing no change. Compared with controls, men both already working in and anticipating transfer to an executive agency experienced significant increases in health self-rated as "average or worse", longstanding illness, adverse sleep patterns, mean number of symptoms in the fortnight before questionnaire completion, and minor psychiatric morbidity. Significant relative increases in body mass index were seen in both exposure groups while exposure to agency status was also associated with significant relative increases in blood pressure. Health-related behaviours, where they differed between exposure and control groups, tended to favour those in the exposure groups. Compared with controls, women in both exposure groups reported small increases in most self-reported morbidity measures and most clinical measurements, accompanied by slight beneficial changes in some health-related behaviours and small adverse changes in others. Significant relative increases were seen in mean number of symptoms, and ischaemia among women anticipating exposure and in body mass index among those exposed to agency status. Policy makers should be aware of the wider consequences of job insecurity when considering the efficiency of changes in employment policy.

Adult↗
PubMed1998

Job control, personal characteristics, and heart disease.

This study examined the role of several personal characteristics in the association between low job control and coronary heart disease among male and female British civil servants. The logistic regression analyses were based on a prospective cohort study (Whitehall II), comprising 6,895 men and 3,413 women, age 35-55 years. Men and women with low job control at baseline had 1.5 to 1.8 higher risks of new heart disease during the 5.3-year follow-up. Psychological attributes, such as hostility, negative affectivity, minor psychiatric disorder, and coping, affected this association very little. The personal characteristics were not confounders, intermediate factors, or effect modifiers. Hence, increasing job control could, in principle, lower risks of heart disease for all employees.

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PubMed1998

Contribution of psychosocial factors to socioeconomic differences in health.

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents' education, smoking behavior, and social relations contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower socioeconomic status have worse health and lower psychological well-being.

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PubMed1998

An uncertain future: the health effects of threats to employment security in white-collar men and women.

OBJECTIVES: This study examined changes in the health status of civil servants whose employment security was threatened. METHODS: Data were derived from a longitudinal cohort of 10,308 men and women, office staff in 20 British civil service departments. Physiological measurements, self-reported morbidity, and health-related behaviors for 530 members of the department under threat were compared with those of 19 other departments, during the period of uncertainty and during stable employment 5 years earlier. RESULTS: From a position of advantage or no difference at baseline, self-reported morbidity and physiological risk factors tended to increase among respondents from the threatened department compared with those from other departments. For both sexes, increases were significant for body mass index (P < .001) and sleeping 9 or more hours (odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.3, 2.8; P < .01); modest but significant increases were seen in ischemia (OR = 1.45; 95% CI = 1.0, 2.1) and cholesterol concentration (0.08 mmol/L; 95% CI = 0.01, 0.14). Among women only, a significant relative increase in blood pressure (P < .01) was recorded. Over the same period health-related behaviors changed little. CONCLUSIONS: Threats to employment security have adverse consequences for health status that are unexplained by health selection or health-related behaviors.

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PubMed1997

Contribution of job control and other risk factors to social variations in coronary heart disease incidence.

BACKGROUND: The first Whitehall Study showed an inverse social gradient in mortality from coronary heart disease (CHD) among British civil servants--namely, that there were higher rates in men of lower employment grade. About a quarter of this gradient could be attributed to coronary risk factors. We analysed 5-year CHD incidence rates from the Whitehall II study to assess the contribution to the social gradient of psychosocial work environment, social support, coronary risk factors, and physical height. METHODS: Data were collected in the first three phases of examination of men and women in the Whitehall II study. 7372 people were contacted on all three occasions. Mean length of follow-up was 5.3 years. Characteristics from the baseline, phase 1, questionnaire, and examination were related to newly reported CHD in people without CHD at baseline. Three self-reported CHD outcomes were examined: angina and chest pain from the Rose questionnaire, and doctor-diagnosed ischaemia. The contribution of different factors to the socioeconomic differences in incident CHD was assessed by adjustment of odds ratios. FINDINGS: Compared with men in the highest grade (administrators), men in the lowest grade (clerical and office-support staff) had an age-adjusted odds ratio of developing any new CHD of 1.50. The largest difference was for doctor-diagnosed ischaemia (odds ratio for the lowest compared with the highest grade 2.27). For women, the odds ratio in the lowest grade was 1.47 for any CHD. Of factors examined, the largest contribution to the socioeconomic gradient in CHD frequency was from low control at work. Height and standard coronary risk factors made smaller contributions. Adjustment for all these factors reduced the odds ratios for newly reported CHD in the lowest grade from 1.5 to 0.95 in men, and from 1.47 to 1.07 in women. INTERPRETATION: Much of the inverse social gradient in CHD incidence can be attributed to differences in psychosocial work environment. Additional contributions were made by coronary risk factors--mainly smoking--and from factors that act early in life, as represented by physical height.

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PubMed1997

Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study.

OBJECTIVE: To determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants. DESIGN: Prospective cohort study (Whitehall II study). At the baseline examination (1985-8) and twice during follow up a self report questionnaire provided information on psychosocial factors of the work environment and coronary heart disease. Independent assessments of the work environment were obtained from personnel managers at baseline. Mean length of follow up was 5.3 years. SETTING: London based office staff in 20 civil service departments. SUBJECTS: 10,308 civil servants aged 35-55 were examined-6895 men (67%) and 3413 women (33%). MAIN OUTCOME MEASURES: New cases of angina (Rose questionnaire), severe pain across the chest, diagnosed ischaemic heart disease, and any coronary event. RESULTS: Men and women with low job control, either self reported or independently assessed, had a higher risk of newly reported coronary heart disease during follow up. Job control assessed on two occasions three years apart, although intercorrelated, had cumulative effects on newly reported disease. Subjects with low job control on both occasions had an odds ratio for any subsequent coronary event of 1.93 (95% confidence interval 1.34 to 2.77) compared with subjects with high job control at both occasions. This association could not be explained by employment grade, negative affectivity, or classic coronary risk factors. Job demands and social support at work were not related to the risk of coronary heart disease. CONCLUSIONS: Low control in the work environment is associated with an increased risk of future coronary heart disease among men and women employed in government offices. The cumulative effect of low job control assessed on two occasions indicates that giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease.

Adult↗
PubMed1997

Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study.

This report describes the social distribution of central obesity and the metabolic syndrome at the Whitehall II study phase 3 examination, and assesses the contribution of health related behaviours to their distribution. Cross-sectional analyses were conducted utilising data collected in 1991-1993 from 4978 men and 2035 women aged 39-63 years who completed an oral glucose tolerance test. There was an inverse social gradient in prevalence of the metabolic syndrome. The odds ratio (95% confidence interval) for having the metabolic syndrome comparing lowest with highest employment grade was: men 2.2 (1.6-2.9), women 2.8 (1.6-4.8). Odds ratios for occupying the top quintile of the following variables, comparing lowest with highest grade, were, for waist-hip ratio: men 2.2 (1.8-2.8), women 1.6 (1.1-2.4); post-load glucose: men 1.4 (1.1-1.8), women 1.8 (1.2-2.6); triglycerides: men 1.6 (1.2-2.0), women 2.2 (1.5-3.3); fibrinogen: men 1.7 (1.4-2.3), women 1.9 (1.2-2.8). Current smoking status, alcohol consumption and exercise level made a small contribution (men 11%, women 9%) to the inverse association between socioeconomic status and metabolic syndrome prevalence. In conclusion, central obesity, components of the metabolic syndrome and plasma fibrinogen are strongly and inversely associated with socioeconomic status. Our findings suggest the metabolic syndrome may contribute to the biological explanation of social inequalities in coronary risk. Health related behaviours appear to account for little of the social patterning of metabolic syndrome prevalence.

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PubMed1997

The effects of blood pressure resting level and lability on cardiovascular reactions to laboratory stress.

Evidence that individuals with elevated resting blood pressures display excessive cardiovascular reactions to laboratory stress is regarded as implicating excessive reactivity in the pathogenesis of hypertension. However, it remains possible that this relationship is artifactual, in that resting blood pressure levels and cardiovascular reactions might both reflect intrinsic cardiovascular lability. To examine this possibility, blood pressure and heart rate were measured at rest and in response to an active laboratory stressor in 1259 men. Systolic blood pressure and heart rate reactions to the stressor were predicted by resting blood pressure. Although cardiovascular lability showed some association with both reactivity and resting blood pressure level, the resting blood pressure level-reactivity relationship survived statistical adjustment for such associations. Accordingly, the excessive cardiovascular reactions characteristic of individuals with elevated resting blood pressure would not appear to be explainable, to any substantial extent, by lability effects.

Adult↗
PubMed1997

The relationship between socioeconomic status, hostility, and blood pressure reactions to mental stress in men: data from the Whitehall II study.

This study investigated the relationship among blood pressure reactions to mental stress, cynical hostility, and socioeconomic status (SES) in 1,091 male public servants. Occupational grade served to index SES and cynical hostility was assessed using the Cook-Medley scale. (Cook & Medley, 1954). The magnitude of systolic, but not diastolic, blood pressure change scores to stress was positively associated with occupational grade: the higher the grade, the greater the reactions. Mental stress task performance also varied with occupational grade but was unrelated to reactivity. Ratings of task difficulty did not vary with occupational grade. Cynical hostility was negatively related to occupational grade, and, contrary to previous findings, negatively related to systolic blood pressure reactivity. Cynical hostility was also negatively related to mental stress task performance but unrelated to ratings of task difficulty.

Adult↗
PubMed1997

Dietary assessment in Whitehall II: the influence of reporting bias on apparent socioeconomic variation in nutrient intakes.

OBJECTIVE: To assess socio-economic differences in nutrient intake, giving particular consideration to the influence of reporting bias. DESIGN: Cross-sectional study. Three methods of data analysis (inclusion of all subjects, exclusion of low energy reporters, and regression-based energy adjustment) were evaluated against biomarkers of fatty acid and antioxidant intakes. SETTING: London-based Civil Servants. SUBJECTS: Age and employment grade stratified random sub-sample of 459 men and 406 women aged 39-61 y who completed 7 d diet diaries at Phase 3 follow-up (1991-93) of the Whitehall II Study. DIETARY MEASURES: Mean daily intakes by employment grade (6 levels) of dietary energy, total fat, saturated fatty acids, polyunsaturated fatty acids (PUFA), linoleic acid, carbohydrate excluding fibre, dietary fibre, protein, alcohol, vitamin C, vitamin E, carotenes, potassium and calcium. Biomarkers: serum cholesterol ester fatty acids (CEFA), total cholesterol, plasma alpha-tocopherol and beta-carotene. RESULTS: Low energy reporting (LER), defined as a reported energy intake below 1.2 times calculated basal metabolic rate, was strongly associated with employment grade (top grade: men 17.3%, women 19.3%, bottom grade: men 45.7%, women 49.2% trend P < 0.0001 both sexes). This association is only to a small extent accounted for by the relative weight distribution across grades. The direct associations with grade--high status, high intakes--of total fat, saturated and polyunsaturated fatty acids seen in the results overall were greatly reduced or abolished when LER were excluded or when energy adjustment was used. Direct associations between grade and intakes of vitamin C and potassium in both sexes were evident regardless of data presentation method. Spearman correlations between biomarkers and reported intakes, for example CEFA and dietary linoleate (men 0.46, women 0.61), plasma beta-carotene/cholesterol ratio and dietary carotenes (men 0.16, women 0.21) together with theoretical considerations indicate that energy adjustment may be the preferred method for reducing the influence of reporting bias. CONCLUSIONS: Low energy reporting is a major source of bias in dietary surveys and its prevalence shows a marked inverse association with socio-economic status. The energy adjustment method provides an approach which reduces this bias without exclusion of low energy reporters. Intakes of micronutrients including vitamin C, rather than fatty acids, showed associations with socio-economic status consistent with a dietary explanation for social inequalities in cardiovascular disease.

Adult↗
PubMed1997

The effects of recent food, alcohol, and tobacco intake and the temporal scheduling of testing on cardiovascular activity at rest and during psychological stress.

Participants in cardiovascular psychophysiological studies receive various instructions regarding restraints on alcohol, food, and tobacco intake prior to testing. Further, although the hour of testing is frequently a concern, little attention is paid to month of the year. In the present study, we examined cardiovascular activity at rest and in response to a laboratory stress task in 1,272 men in terms of these variables. Alcohol consumption among alcohol users and food intake within 4 hr of testing were associated with higher baseline diastolic blood pressure (BP) but lower baseline heart rate (HR). Tobacco use in smokers within 1 hr of testing was associated with elevated baseline BP and HR. Hour of testing was related to baseline HR, whereas month of the year was associated with baseline BP. In contrast to these baseline effects, cardiovascular reactions to the laboratory stress task were largely immune to these contextual influences.

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