Early life and adult disorder: research themes.
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Adult↗
Biomedical subjects
M G Marmot
Publications and source records attributed to M G Marmot.
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.
Adult↗
Reference values for alpha-tocopherol and beta-carotene in the Whitehall II Study.
Plasma alpha-tocopherol, beta-carotene, serum lipids and their derived ratios were determined in British Civil Servants (n = 7177) at the second medical examination of the Whitehall II Study, a longitudinal study of cardiovascular disease. For plasma alpha-tocopherol the non-parametric 95% reference interval (90% confidence limits) for the total population was: 11.1 (10.9-11.3)-51.5 (50.6-52.7) mumol/l. For plasma beta-carotene the non-parametric reference interval for the total population was: 0.05 (0.05-0.05)-2.14 (2.08-2.21) mumol/l. The latter interval was wider than those previously published with a higher mean (0.61 mumol/l) and median (0.75 mumol/l). Plasma beta-carotene concentrations were higher in women than men with age-adjusted means of 0.70 and 0.57 mumol/l respectively (p < 0.001). This may reflect differences in diet, lifestyle and metabolism between the sexes. The alpha-tocopherol/cholesterol ratio, as in other surveys, did not vary with age. Among men, current- and ex-smokers had a higher alpha-tocopherol/cholesterol ratio than never-smokers with age-adjusted means of 4.18, 4.19 mumol/mmol and 4.05 mumol/mmol respectively. This difference is as yet unexplained. Follow-up of these subjects will help to clarify the role of antioxidant nutrients as protective factors for cardiovascular disease and cancer.
Adult↗
Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study.
OBJECTIVE: To assess the risk of death associated with work based and non-work based measures of socioeconomic status before and after retirement age. DESIGN: Follow up study of mortality in relation to employment grade and car ownership over 25 years. SETTING: The first Whitehall study. SUBJECTS: 18,133 male civil servants aged 40-69 years who attended a screening examination between 1967 and 1970. MAIN OUTCOME MEASURE: Death. RESULTS: Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40-64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidence interval 2.4 to 4.1). After retirement the ability of grade to predict mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality less well than employment grade before retirement but its ability to predict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconomic groups showed employment grade and car ownership to have independent associations with mortality that were of equal magnitude after retirement. The absolute difference in death rates between the lowest and highest employment grades increased with age from 12.9 per 1000 person years at ages 40-64 to 38.3 per 1000 at ages 70-89. CONCLUSIONS: Socioeconomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based on an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an important part in generating social inequalities in health in men of working age.
Adult↗
Occupation and ischemic heart disease in the European Community: a comparative study of occupations at potential high risk.
Four longitudinal studies of mortality and morbidity by occupation based on individual record linkage of information and two cross-sectional studies of mortality were compared in order to identify occupations at high risk of ischemic heart disease. In more than one country an increased risk of ischemic heart disease was found in drivers of buses, taxies, and lorries, in bakers, in naval officers and fishermen, in hotel and restaurant workers, in senior police, customs, and other uniformed men, in barbers and hairdressers, in warehouse and wholesale staff, as well as in laboratory assistants and in radio and telegraph operators. Occupations found at high risk in Denmark were also found at high risk in Great Britain and Italy. These occupations may be at genuine high risk. None of these groups work day-work only and several of the groups have psychologically demanding work but unsatisfactory decision authority. Identification of occupations at high risk may help to develop focused preventive strategies.
Adolescent↗
The relationship between plasma cholesterol concentration and minor psychiatric disturbance in the Department of the Environment Study.
We examined the hypothesis that low plasma cholesterol concentration was associated with minor psychiatric disturbance in a cross-sectional study of 410 male and 138 female civil servants. Psychiatric disturbance was measured using the 30-item General Health Questionnaire (GHQ). Mean GHQ score did not vary significantly with quartile of total cholesterol concentration. After adjustment for confounding variables a significant trend of increasing mean GHQ with increasing cholesterol concentration emerged. In a logistic regression analysis subjects in the highest quartile of cholesterol concentration had an adjusted odds ratio for being a "psychiatric case" of 2.0 (95% confidence interval, 1.1-2.5) compared with those in the lowest quartile. This relationship reversed when using a higher cutoff point to define more severe cases, although the trend was not statistically significant.
Adult↗
Oral contraceptives and thrombotic diseases: impact of new epidemiological studies.
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Age Distribution↗
Reliability of data from proxy respondents in an international case-control study of cardiovascular disease and oral contraceptives. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.
STUDY OBJECTIVES: To evaluate the reliability of data supplied in a case-control study by proxy respondents for cases who were too ill to do so themselves. DESIGN: A hospital based, case-control study of the current use of oral contraceptives (OC) and cardiovascular diseases. Data from "true" controls matched to a subset of cases were compared with those supplied by proxy respondents about the true controls. SETTING: Hospitals in 21 centres from Africa, Asia, Europe, and Latin America. PATIENTS AND PARTICIPANTS: For a subset of cases, 403 pairs of controls-one "true" and one proxy-were interviewed. "True" controls were matched by age, place, and time of admission and were admitted with 1 of 27 permissible diagnoses not associated with OC use. Proxy controls were either relatives or friends of true controls. MAIN RESULTS: Levels of concordance between data from proxy and true controls were high for most variables regarding recent events, including current OC use, but were greatly diminished when detailed information, particularly from the past, was required. Husbands were usually the best proxy, although this was question-specific. The sensitivity and specificity of proxy responses were 93% (95% confidence intervals: 77%, 99%) and 100% (98%, 100%) respectively, for current use of OC. Assuming the misclassification of current OC use by proxy cases is similar to that produced by proxy controls, the estimated impact of using proxy data on risk estimates associated with current OC use was to bias the overall estimate of risk of stroke by less than 3% and the risks of both acute myocardial infarction and venous thromboembolism by less than 1%. CONCLUSIONS: Friends or relatives, and particularly husbands, provided reliable information when used as proxy respondents for young women. The estimated impact of misclassification by proxy respondents on overall risk estimates in the WHO collaborative study was less than that which would have arisen if information from proxy respondents had not been used.
Adult↗
Socio-economic factors in cardiovascular disease.
INCREASING RATES OF CARDIOVASCULAR DISEASE AMONG LOWER SOCIO-ECONOMIC GROUPS: Evidence from English studies indicates that not only is cardiovascular disease mortality more common among lower social classes, but there is an inverse social gradient. For example, one study showed that the higher the employment grade the lower the mortality, a finding that also held for most of the major causes of death. Between the early 1970s and early 1980s, coronary heart disease mortality rates declined by 15% in men in non-manual occupations and increased by 1% in manual occupations. Differences could not be attributed to medical care alone. This widening social gap in mortality rates has continued, and a similar pattern has been observed in other countries. EAST-WEST DIFFERENCES: Through the 1950s and 1960s, cardiovascular mortality and life expectancy were similar in central European countries on both sides of the iron curtain. From the late 1960s, however, there was marked divergence in mortality rates with improvement in the West and stagnation or deterioration in the countries of central and eastern Europe. After 1989 with the lifting of the iron curtain, Russia and some other eastern countries began to show a marked deterioration in life expectancy. In Russia life expectancy appears to have declined from 63 to 59 years in about 4 years. CURRENT RESEARCH ON MULTIPLE PATHWAYS: As we understand more of the biological mechanisms underlying the pathogenesis of cardiovascular disease, the more it becomes clear that these processes have multiple influences driving them. In our current research, we are using a model of potential pathways linking socio-economic status to diabetes mellitus and coronary heart disease in an attempt to confirm or refute the links in this model.
Behavior↗
Health effects of anticipation of job change and non-employment: longitudinal data from the Whitehall II study.
OBJECTIVE: To assess the effect of anticipating job change or non-employment on self reported health status in a group of middle aged male and female white collar civil servants. DESIGN: Longitudinal cohort study (Whitehall II study). Questionnaire data on self reported health status and health behaviour were obtained at initial screening and four years later, during the period when employees of the department facing privatisation were anticipating job change or job loss. SETTING: London based office staff in 20 civil service departments. SUBJECTS: 666 members of one department threatened with early privatisation were compared with members of the 19 other departments. MAIN OUTCOME MEASURES: Self reported health status measures and health related behaviours, before and during anticipation of privatisation. RESULTS: In comparison to the remainder of the cohort, the profile of health related behaviours of cohort members who faced privatisation was more favourable, both before and during anticipation of privatisation. There were no significant differences in the changes in health behaviours between cohort members moving into a period of job insecurity and the remainder of the cohort. Self reported health status, however, tended to deteriorate among employees anticipating privatisation when compared with that of the rest of the cohort. CONCLUSIONS: The application of a longitudinal design, allowing the same individuals to be followed from job security into anticipation, provides more robust evidence than has previously been available that anticipation of job loss affects health even before employment status has changed.
Adaptation, Psychological↗
Pressor reactions to psychological stress and prediction of future blood pressure: data from the Whitehall II Study.
OBJECTIVE: To examine whether reactions of blood pressure to psychological stress predict future blood pressure. DESIGN: Blood pressure was recorded at a medical screening examination after which pressor reactions to a psychological stress task were determined. Follow up measurement of blood pressure was undertaken, on average, 4.9 years later. SETTING: 20 civil service departments in London. SUBJECTS: 1003 male civil servants aged between 35 and 55 years at entry to the study. MAIN OUTCOME MEASURE: Blood pressure at follow up screening. RESULTS: Reactions of systolic blood pressure to stress correlated positively with systolic blood pressure at follow up screening (r = 0.22, P < 0.01). The dominant correlate of follow up blood pressure was blood pressure at initial screening (r = 0.60; P < 0.01 between initial and follow up systolic blood pressure; r = 0.59, P < 0.01 between initial and follow up diastolic blood pressure). Stepwise multiple regression analysis indicated that reactions to the stressor provided minimal prediction of follow up blood pressure over and above that afforded by blood pressure at initial screening. In the case of follow up systolic blood pressure, systolic reactions to stress accounted for only 1% of follow up variance; systolic blood pressure at initial screening accounted for 34%. With regard to diastolic blood pressure at follow up, the independent contribution from diastolic reactions to stress was less than 1%. CONCLUSION: Pressor reactions to psychological stress provide minimal independent prediction of blood pressure at follow up. Measurement of reactivity is not a useful clinical index of the course of future blood pressure.
Adult↗
Different trends in serum cholesterol levels among rural and urban populations aged 40-59 in Japan from 1960 to 1990.
In Japan, coronary heart disease mortality is low and has been declining since 1970, despite recent increases in serum cholesterol levels which have been reported in nationwide surveys. Longitudinal and cross-sectional surveys of serum cholesterol levels in rural and urban populations from 1960 to 1990 were reviewed. In the surveys in the 1960s, serum cholesterol levels in urban populations were higher than those in rural populations. An increase in serum cholesterol levels for men and women was observed in all longitudinal studies among rural populations; mean increases in serum cholesterol levels per year were 0.034 mmol/l (p < 0.001) and 0.033 mmol/l (p < 0.001), respectively. These trends were still observed after combining the data from the longitudinal and cross-sectional studies in both men and women (0.027 and 0.028 mmol/l per year, respectively), while there was no significant increase among urban populations. The results of National Nutrition Surveys are consistent with these findings and show that meat consumption per day per capita increased from 23.9 to 66.2 g in rural populations and 51.2 to 77.6 g in urban populations in the 1966 and 1990 surveys. It is suggested that different trends in coronary heart disease mortality should also be apparent in rural and urban populations over this period.
Adult↗
Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.
Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin's lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological studies would be worthwhile to investigate the reasons for the sizeable decreased risk of colon and rectal cancer and increased risk of gall bladder cancer in each sex and the increased risk of thyroid and laryngeal cancer in males and oesophageal cancer in females of Indian ethnicity but not of British ethnicity who have migrated from the Indian subcontinent.
Adolescent↗
Population science, prejudice and policy on alcohol.
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Alcohol Drinking↗
Work characteristics and psychiatric disorder in civil servants in London.
STUDY OBJECTIVE: To describe the association between self reported and externally assessed work characteristics and psychiatric disorder. DESIGN: Analysis of questionnaire data collected from the first phase of the Whitehall II study, a cohort study of an employed population. SETTING: Twenty civil service departments in London. PARTICIPANTS: Altogether 6900 male and 3414 female civil servants aged 35-55 years. MAIN RESULTS: High levels of subjective social support at work, control at work, job variety, and skill use were associated with greater satisfaction and wellbeing and less psychiatric disorder measured by the 30 item general health questionnaire (GHQ). High levels of subjective work pace and conflicting demands were associated with less satisfaction and wellbeing and greater psychiatric disorder. The combined effects of work characteristics were similar to the effects of the work characteristics considered separately, except that for men there was a small interaction between psychological demands and control on the GHQ. There was little overall support for the two factor job strain model. In contrast, objective indices of work were generally not associated with the psychological indices. Findings in men and women were generally comparable and were not significantly influenced by employment grade. CONCLUSIONS: Negative affectivity and a tendency to report negatively about both work and the psychological indices may partly explain the difference in the findings between subjective and objective work characteristics. However, subjective work characteristics were still associated with psychiatric disorder after adjusting for negative affectivity. The potential confounding effects of employment grade did not explain the association between either subjective or objective work characteristics and the psychological indices. While modifications to the work environment may directly reduce certain adverse physical health effects, the influence of work place design and management on psychological wellbeing, satisfaction, and psychiatric disorder may be mediated through subjective perceptions of the work environment.
Adult↗
Survival and cause of death in a cohort of patients with parkinsonism: possible clues to aetiology?
Most previous studies that have examined the survival of patients with parkinsonism have recruited them from specialist centres. No previous study has ever reported cause specific mortality. We report on the mortality of a cohort of 220 parkinsonian patients recruited between 1970 and 1972 from 40 primary health care practices all over England and Wales and matched to 421 controls. At 20 years of follow up, 195 cases (88.6%) and 295 controls (70.1%) were no longer alive (P < 0.001). The median age at death for cases was 77.6 (range 53.8-97.3) and 83.5 (range 55.0-100.1) for controls (P < 0.001). The all cause hazard ratio for cases compared with controls was 2.6 (95% confidence interval (95% CI) 2.2-3.2) controlling for age, sex, and geographical region. There was little difference between men and women. Differences for cause specific mortality also emerged. Both ischemic heart disease (2.3, 95% CI 1.5-3.4) and cerebrovascular disease (3.6, 95% CI 2.2-6.1) showed significantly increased hazard ratios. Possible reasons for these findings are discussed in terms of (a) competing causes of death, (b) a secondary effect of drug treatment, and (c) common aetiological factors for both parkinsonism and cardiovascular disease.
Aged↗
Hypertensive retinopathy in Afro-Caribbeans and Europeans. Prevalence and risk factor relationships.
The prevalence of hypertension is particularly high in people of black African descent throughout the world, and the consequences of hypertension, such as hypertensive heart and renal disease and stroke, are also more common. But there is little consensus on whether hypertensive retinopathy follows a similar pattern. We determined the prevalence of hypertensive retinopathy and its relationships with resting and ambulatory blood pressure in a population study of Afro-Caribbeans and Europeans aged 40 to 64 years in London, UK. Retinal photographs of 651 participants were graded for hypertensive retinopathy. Age- and sex-standardized prevalence of retinopathy was 11% (95% confidence interval, 8% to 14%) in Europeans and 21% (95% confidence interval, 16% to 26%) in Afro-Caribbeans (P < .001), respectively. This ethnic difference in prevalence was greatest in normotensive women (8% in Europeans versus 20% in Afro-Caribbeans, P < .001). Resting systolic pressure was 8 mm Hg higher in normotensive Afro-Carribean compared with European women, but this could not fully account for the ethnic difference in the prevalence of retinopathy. Examination of the different relationships of age and resting and ambulatory blood pressures with hypertensive retinopathy showed that these relationships were strongest in European women and weakest in Afro-Caribbean women. We conclude that hypertensive retinopathy is more common in Afro-Caribbeans, particularly women, and that ethnic differences in resting blood pressure cannot fully account for this. The relatively weak relationship between resting and ambulatory blood pressures and retinopathy in Afro-Caribbeans suggests that factors other than blood pressure determine the high rates of hypertensive retinopathy in this group.
Adult↗
Echocardiographic measures of left ventricular structure and their relation with rest and ambulatory blood pressure in blacks and whites in the United Kingdom.
OBJECTIVES: This study attempted to determine whether people of black African descent have more left ventricular hypertrophy than those of white European descent and whether this can be explained by rest or ambulatory blood pressure. BACKGROUND: Mortality associated with hypertension is higher in black populations than among whites, but differences in morbidity and their associations with blood pressure are inconsistent. METHODS: We examined 1,166 black and white men and women 40 to 64 years old in a community survey in London, United Kingdom. Echocardiograms were obtained for all subjects and ambulatory blood pressure recordings for 319. RESULTS: Adjusted for body size, ventricular septal thickness was greater in blacks than whites (p < 0.05), and cavity dimension was smaller (p < 0.05). In men, ventricular septal thickness was > 10 mm for 32% of whites and 53% of blacks; for women these figures were 14% and 38%, respectively. Relative wall thickness was greater in blacks (p < 0.01 for men and women), but left ventricular mass index was similar in the two ethnic groups. In men, hypertension resulted in an increase in wall thickness in both ethnic groups, but cavity dimension decreased in blacks and increased in whites. Wall thickness was higher in blacks than in whites for equivalent levels of either rest (p = 0.05) or ambulatory (p = 0.007) blood pressure. CONCLUSIONS: Left ventricular mass index may not be valid for comparison between ethnic groups because this derived measure does not take into account ethnic differences in ventricular structural response to hypertension. Interventricular wall thickness may be more valid. Using this measure, we demonstrate greater ventricular hypertrophy in blacks than in whites, unexplained by differences in either rest or ambulatory blood pressure. The pattern of ventricular hypertrophy observed in blacks is associated with an increased mortality risk. Conventional blood pressure thresholds for instituting antihypertensive treatment may be too conservative for people of black African descent.
Adult↗