Search PubMed⌕ Search

Biomedical subjects

M G Marmot

Publications and source records attributed to M G Marmot.

At least 37 records · Page 2Linked to original sources
PubMed2001

The relationship between job strain and coronary heart disease: evidence from an english sample of the working male population.

BACKGROUND: Many, but not all, studies have reported that job strain is related to cardiovascular morbidity and mortality. To date, this relationship has not been tested on an English full population sample. This study examines whether the demand-control model of job strain contributes to our understanding of the determinants of coronary heart disease. METHODS: The analysis uses data from 4350 working men aged 20-64 in the 1993 Health Survey for England. Job demand and control characteristics were determined by questionnaire. Several health outcomes were examined: self-rated health; psychiatric health; angina and possible myocardial infarction, measured by the Rose questionnaire; doctor-diagnosed heart disease; any heart disease. The relationship between job strain and the health outcomes was determined by logistic regression analyses after controlling for known confounders. RESULTS: Those in high strain jobs consistently reported poorer health on all measures than men with lower strain. Similarly, men reporting low job strain were least likely to report poor health in 5/6 health outcomes. Those with intermediate levels of strain tended to have intermediate prevalence rates for poor health. The pattern of association between job strain and the CHD was independent of coronary risk factors. CONCLUSIONS: The analyses broadly support Karasek's demand-control model of job strain. Health selection into low strain jobs may account for the lack of an association between job strain and doctor diagnosed heart disease while independent associations between job strain and all CHD measures considered together indicate that job strain may have aetiological significance for heart disease.

Adult↗
PubMed2001

Job insecurity in white-collar workers: toward an explanation of associations with health.

This article describes 2 studies that examined changes in psychosocial work characteristics (job strain model) and health-related behaviors as potential explanations of the job insecurity-health relationship in a longitudinal cohort of white-collar British civil servants. Job insecurity arising from anticipation of change was associated with a modest increase in self-reported morbidity, whereas chronic job insecurity was associated with some adverse physiological changes. Anticipation of change and chronic job insecurity were associated with adverse changes in other psychosocial work characteristics, but few changes were significant and consistent across both exposure groups. Changes in health-related behaviors associated with either exposure were slight. Apart from a minor role for social support at work in both sexes and a modest role for job demands in women, adverse changes in these factors explain little of the job insecurity-health relationship.

Adult↗
PubMed2001

What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study.

OBJECTIVE: Saturated fats have adverse effects on health. To investigate which is more beneficial for energy replacement, we compare the effects of polyunsaturated fatty acid and carbohydrate intake on obesity and metabolic variables (fasting triglycerides, HDL-cholesterol, LDL-cholesterol and 2 h glucose). Further, because the optimum diet may differ according to glucose tolerance, we examine the same associations in glucose tolerant and intolerant groups. Finally, we test the effect of macronutrient intake on the presence or absence of the metabolic syndrome. DESIGN: Cross-sectional analysis. SUBJECTS: A total of 4497 men and 1865 women aged 39--62 in the Whitehall II study. RESULTS: In men, higher intakes of both polyunsaturated fats and carbohydrates were linked to lower waist-hip ratio, triglycerides and LDL-cholesterol. Higher carbohydrate intake alone was linked to decreased body mass index (for 10 g higher carbohydrate intake, -0.12 kg/m(2), P<0.0001) and lower HDL-cholesterol (-0.01 mmol/l, P<0.01). In normoglycaemic men, higher carbohydrate intakes were associated with higher 2 h insulin and glucose levels (0.25 pmol/l, P<0.05 and 0.01 mmol/l, P=0.001, respectively). Dietary effects among women were similar, the exception being a positive association of polyunsaturated fat intake with body mass index and waist--hip ratio (0.47 kg/m(2), P<0.05 and 0.006, P<0.05, respectively). Dietary components, with the exceptions of cholesterol and protein in men, were unrelated to prevalence of the metabolic syndrome, and adjustment for differences in macronutrient intake did not account for the strong inverse association between socioeconomic position and the metabolic syndrome. CONCLUSION: Our observational data provide evidence that both polyunsaturated fatty acids and carbohydrates offer small metabolic benefits with few adverse effects compared with saturated fats. International Journal of Obesity (2001) 25, 45-53

Adult↗
PubMed2001

Alcohol and coronary heart disease.

The data on two questions are reviewed: does heavy alcohol intake increase the risk of coronary heart disease (CHD)? And, is moderate intake protective? Identified alcoholics and problem drinkers have an increased risk of CHD, and in Britain there is a correlation among 22 towns, between the proportion of heavy drinkers in a town and CHD mortality. Of seven longitudinal studies reviewed, one shows heavy drinkers to have an increased CHD incidence. An inverse association between alcohol consumption and CHD mortality is seen in international comparisons and in time trends in the USA. Of six case-control studies reviewed from England and the USA, all show an inverse association between CHD and alcohol consumption which persists after control for other risk factors. Longitudinal studies, in Japanese-Americans, white American men and women, British civil servants, Puerto Ricans, Yugoslavs and Australians, all show moderate drinkers to have a lower CHD risk than abstainers. Abstainers are likely to differ from moderate drinkers in a number of ways. To date it has not proved possible to show that any of these differences account for the higher CHD risk of abstainers. The apparent protective effect is not large (RR = 0.5) but the consistency of the association and the existence of plausible mechanisms increase the likelihood that the negative association is causal. However, if alcohol intake were to increase in the population the social and medical consequences would be large. An increased intake is therefore not recommended as a community measure for CHD prevention.

Alcohol Drinking↗
PubMed2001

Socioeconomic differences in behavioural and biological risk factors: a comparison of a Japanese and an English cohort of employed men.

BACKGROUND: To compare socioeconomic differences in behavioural and biological risk factors in Japanese and English 39-59-year-old employed men. METHODS: We measured systolic and diastolic blood pressure, total and high density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-to-hip ratio and fibrinogen at medical screenings and smoking and alcohol consumption in health questionnaires among Japanese non-manual and manual employees of a steel products company and among English non-manual employees working in Civil Service departments. RESULTS: In England, higher employment grades were advantaged with regard to most risk factors studied. In Japan the picture was different in that higher grades had higher BMI, waist-to-hip-ratio and lower HDL cholesterol. In Japan employment grade differences in these three risk factors are clearly larger among younger men than among older men, while in England age differentials in the grade differences are small. Similar results were obtained for education. CONCLUSIONS: Important differences in the social patterning of risk factors were observed in our cohorts of employed Japanese and English men. The contribution that these risk factors make in explaining social differences in health may vary accordingly. Studies that identify the common and unique determinants of socioeconomic health differences in different populations are needed.

Adult↗
PubMed2001

Seasonal variation in cause-specific mortality: are there high-risk groups? 25-year follow-up of civil servants from the first Whitehall study.

OBJECTIVES: To determine the seasonal effect on all-cause and cause-specific mortality and to identify high-risk groups. METHODS: A 25-year follow-up of 19,019 male civil servants aged 40-69 years. RESULTS: All-cause mortality was seasonal (ratio of highest mortality rate during winter versus lowest rate during summer 1.22, 95% CI : 1.1-1.3), largely due to the seasonal nature of ischaemic heart disease. Participants at high risk based on age, employment grade, blood pressure, cholesterol, forced expiratory volume, smoking and diabetes did not have higher seasonal mortality, although participants with ischaemic heart disease at baseline did have a higher seasonality effect (1.38, 95% CI : 1.2-1.6) than those without (1.18, 95% CI : 1.1-1.3) (P = 0.03). CONCLUSIONS: Seasonal mortality differences were greater among those with prevalent ischaemic heart disease and at older ages, but were not greater in individuals of lower socioeconomic status or with a high multivariate risk score. Since seasonal differences showed no evidence of declining over time, elucidating their causes and preventive strategies remains a public health challenge.

Adult↗
PubMed2001

A comparison of left ventricular abnormalities associated with glucose intolerance in African Caribbeans and Europeans in the UK.

OBJECTIVE: To determine whether abnormalities of the left ventricle differ by glucose tolerance status, to explore reasons for differences, and to assess ethnic differences in these relations. DESIGN: Population based prevalence study. SETTING: London, UK. PATIENTS: 1152 African Caribbeans and Europeans. METHODS: Echocardiograms, blood pressure, obesity, fasting and two hour blood glucose, insulin and lipids, and urinary albumin excretion rate were measured. MAIN OUTCOME MEASURES: Left ventricular mass index, wall thickness, and early (E) to atrial (A) wave ratio. RESULTS: Left ventricular mass index was greater in diabetic Europeans than in normoglycaemic Europeans (mean (SE), 95.6 (5.0) v 79.7 (0.8) g/m(2), p = 0.001) and in diabetic African Caribbeans than in normoglycaemic African Caribbeans (88.6 (2.5) v 82.4 (0.9) g/m(2), p = 0.02). Similar, but weaker associations were observed for the E:A ratio. beta Coefficients between left ventricular mass index and fasting glucose in the normoglycaemic range, adjusted for age and sex, were 2.43 in Europeans (p = 0.05) and 3.74 in African Caribbeans (p = 0.02). These were attenuated to 1.19 (p = 0.4) and 3.03 (p = 0.08) in Europeans and African Caribbeans, respectively, when adjusted further for blood pressure and obesity. Adjustments for other risk factors made little difference to the coefficients. There were no ethnic differences in risk factor relations. CONCLUSIONS: Abnormalities of the left ventricle occur in response to glucose intolerance and are observable into the normoglycaemic range. These disturbances are largely accounted for by associated obesity and hypertension. African Caribbeans have a greater degree of left ventricular structural impairment, emphasising the importance of tight blood pressure control.

Adult↗
PubMed2001

Decline of the relative risk of death associated with low employment grade at older age: the impact of age related differences in smoking, blood pressure and plasma cholesterol.

STUDY OBJECTIVE: To explore whether the observed age related decline in the relative risk of death associated with low employment grade can be explained by the profiles of smoking, blood pressure and plasma cholesterol changing differently with age between the employment grades. DESIGN: Prospective cohort study with 25 years of mortality follow up. SETTING: Whitehall study. PARTICIPANTS: There were 16,984 men aged 40 to 69 years at baseline with complete information on smoking, blood pressure and plasma cholesterol. MAIN RESULTS: The relative risk of death associated with low employment grade decreased from 2.1 at 55-59 years of age to 1.3 at 85-89 years of age. Adjustment for smoking status and blood pressure, attenuated the age related decline of the relative risk by 18% and 3% respectively; adjustment for plasma cholesterol increased the decline by 3%. Taken together, these risk factors explain 20% of the observed age related decline. CONCLUSIONS: A small part of the observed age related decline in the relative risk of death associated with low employment grade can be explained by differential changes in the profiles of smoking, blood pressure and plasma cholesterol with age between the employment grades.

Adult↗
PubMed2001

Association between smoking and blood pressure: evidence from the health survey for England.

Cigarette smoking causes acute blood pressure (BP) elevation, although some studies have found similar or lower BPs in smokers compared with nonsmokers. Cross-sectional data from 3 years (1994 to 1996) of the annual Health Survey for England were used to investigate any difference in BP between smokers and nonsmokers in a nationally representative sample of adults (>/=16 years old). Randomly selected adults (33 860; 47% men) with valid body mass index (BMI) and BP measurements provided data on smoking status (never, past, or current) and were stratified into younger (16 to 44 years old) and older (>/=45 years old) age groups. Analyses provided between 89% and 94% power to detect a difference of 2 mm Hg systolic BP between smokers and nonsmokers in the 4 age/gender strata (alpha=0.05). Older male smokers had higher systolic BP adjusted for age, BMI, social class, and alcohol intake than did nonsmoking men. No such differences were seen among younger men or for diastolic blood pressure in either age group. Among women, light smokers (1 to 9 cigarettes/d) tended to have lower BPs than heavier smokers and never smokers, significantly so for diastolic BP. Among men, a significant interaction between BMI and the BP-smoking association was observed. In women, BP differences between nonsmokers and light smokers were most marked in those who did not drink alcohol. These data show that any independent chronic effect of smoking on BP is small. Differences between men and women in this association are likely to be due to complex interrelations among smoking, alcohol intake, and BMI.

Adolescent↗
PubMed2001

Do socioeconomic disadvantages persist into old age? Self-reported morbidity in a 29-year follow-up of the Whitehall Study.

OBJECTIVES: This study examined (1) the relation of employment grade in middle age to self-reported poor health and functional limitations in old age and (2) whether socioeconomic status at approximately the time of retirement modifies health differentials in old age. METHODS: Survivors of the Whitehall Study cohort of men were resurveyed. Respondents were aged 40 to 69 years when they were originally screened in 1967 to 1970. RESULTS: Compared with senior administrators, men in clerical or manual (low-grade) jobs in middle age had quadruple the odds of poor physical performance in old age, triple the odds of poor general health, and double the odds of poor mental health and disability. At most, 20% of these differences were explained by baseline health or risk factors. Men who moved from low to middle grades before retirement were less likely than those who remained in low grades to have poor mental health. CONCLUSIONS: Socioeconomic status in middle age and at approximately retirement age is associated with morbidity in old age.

Activities of Daily Living↗
PubMed2000

Predictors of early retirement in British civil servants.

BACKGROUND: it is uncertain how recent changes in labour force dynamics may have influenced the increasing numbers of people taking early retirement in industrialized countries. The Whitehall II study provides an opportunity to examine the predictors of early retirement in one of the largest employers in the United Kingdom. METHODS: we examined the factors predicting early retirement in a 7-year follow-up period from 1988 to 1995 using longitudinal data on 2532 male and female London-based civil servants aged between 50 and 59.5 years. Baseline data on employment grade and duration of time working for the Civil Service were obtained from self-completed questionnaires. The primary factors examined included health, work characteristics, questions about job demands and job satisfaction and financial insecurity, wealth and material problems. Time until early retirement was analysed using Cox proportional hazards model. RESULTS: of the 2532 civil servants, 26.7% retired early during the follow-up period. We found that men and women in the higher-paid employment grades, those that had suffered from ill health and those that were less satisfied with their jobs were more likely to retire early, whereas material problems tended to keep people working. CONCLUSIONS: our results show that self-perceived health, employment grade and job satisfaction are all independent predictors of early retirement. Qualitative analyses may further advance our understanding of the retirement process.

Age Factors↗
PubMed2000

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

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.

Administrative Personnel↗
PubMed1999

Effect on stroke of different progestagens in low oestrogen dose oral contraceptives. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

The multicentre WHO collaborative case-control study had limited power to differentiate stroke risks by progestagen component in low dose combined oral contraceptives. Given this caveat, odds ratios for ischaemic, haemorrhagic, and all strokes combined associated with use of oral contraceptives containing desogestrel or gestodene ("third generation") were found to be similar to those containing levonorgestrel in this study.

Adult↗
PubMed1999

Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study.

This study compares risk factors for cardiovascular disease in civil servants of three ethnic groups screened as part of the Whitehall II cohort study. Previously identified risk factors for cardiovascular disease in 360 Afro-Caribbean and 577 South Asian subjects are compared with the 8973 white Caucasian subjects. Controlling for socio-economic status is more precise than in most previous studies of cardiovascular differences between ethnic groups. After controlling for socio-economic confounding factors, age and sex, South Asian subjects were found to have increased prevalence of hypertension (defined as either having systolic pressure of > 160, diastolic pressure of > 95 or being on antihypertensives) OR 2.3 (95% CI 1.6-3.3), diabetes OR 4.2 (95%, CI 3.0-5.8) and a high risk lipid profile, although total cholesterol was lower than in the white population. Afro-Caribbean subjects had more hypertension OR 4.0 (95% CI 2.8-5.7) and diabetes OR 2.8 (95% CI 1.7-4.6), but this was accompanied by a favourable lipid profile with low cholesterol and high HDL. Afro-Caribbean alcohol and smoking habits were low-risk. Socio-economic status was found to be an important confounding factor for ethnic differences in biochemical risk factors for cardiovascular disease. However, adjusting for socioeconomic class only attenuates observed differences; it does not abolish them.

Adult↗
PubMed1999

Socioeconomic differences in weight gain and determinants and consequences of coronary risk factors.

BACKGROUND: The increasing prevalence of overweight and obesity is a major public health concern in many developed countries. OBJECTIVE: We aimed to describe socioeconomic differences in change in body mass index (BMI; in kg/m2) from age 25 y, assess possible factors behind these differences, and study whether socioeconomic differences in a variety of coronary risk factors can be accounted for by change in BMI. DESIGN: The data come from a cohort study of London-based civil servants (Whitehall II), who participated in the first (1985-1988) and third (1991-1993) phases of the study and were 35-55-y old at phase 1: altogether there were 5507 men and 2466 women. Both study phases included a questionnaire and a screening examination. RESULTS: In men and women, employment grade--the measure of socioeconomic status used in this cohort--was strongly related to BMI gain from age 25 y to phase 3 (25 y apart on average). The lower the grade the larger the gain in BMI. Adjustment for health behaviors reduced the grade differences in BMI gain by approximately 20%. A substantial part of the grade differences in diastolic and systolic blood pressure and plasma triacylglycerol concentrations could be accounted for by BMI change from age 25 y. CONCLUSIONS: Grade differences in BMI change are evident, but many of the determinants of these differences remain unknown. If lower-status persons continue to gain weight more rapidly than higher-status persons, overweight is likely to be of growing importance as a pathway to social inequalities in ill health.

Adult↗
PubMed1999

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood.

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.

Adult↗