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Michael Marmot

Publications and source records attributed to Michael Marmot.

At least 37 records · Page 2Linked to original sources
PubMed2005

Does autonomic function link social position to coronary risk? The Whitehall II study.

BACKGROUND: Laboratory and clinical studies suggest that the autonomic nervous system responds to chronic behavioral and psychosocial stressors with adverse metabolic consequences and that this may explain the relation between low social position and high coronary risk. We sought to test this hypothesis in a healthy occupational cohort. METHODS AND RESULTS: This study comprised 2197 male civil servants 45 to 68 years of age in the Whitehall II study who were undergoing standardized assessments of social position (employment grade) and the psychosocial, behavioral, and metabolic risk factors for coronary disease previously found to be associated with low social position. Five-minute recordings of heart rate variability (HRV) were used to assess cardiac parasympathetic function (SD of N-N intervals and high-frequency power [0.15 to 0.40 Hz]) and the influence of sympathetic and parasympathetic function (low-frequency power [0.04 to 0.15 Hz]). Low employment grade was associated with low HRV (age-adjusted trend for each modality, P< or =0.02). Adverse behavioral factors (smoking, exercise, alcohol, and diet) and psychosocial factors (job control) showed age-adjusted associations with low HRV (P<0.03). The age-adjusted mean low-frequency power was 319 ms2 among those participants in the bottom tertile of job control compared with 379 ms2 in the other participants (P=0.004). HRV showed strong (P<0.001) linear associations with components of the metabolic syndrome (waist circumference, systolic blood pressure, HDL cholesterol, triglycerides, and fasting and 2-hour postload glucose). The social gradient in prevalence of metabolic syndrome was explained statistically by adjustment for low-frequency power, behavioral factors, and job control. CONCLUSIONS: Chronically impaired autonomic function may link social position to different components of coronary risk in the general population.

Aged↗
PubMed2005

The role of cognitive ability (intelligence) in explaining the association between socioeconomic position and health: evidence from the Whitehall II prospective cohort study.

Associations among cognitive ability, socioeconomic position, and health have been interpreted to imply that cognitive ability could explain social inequalities in health. The authors test this hypothesis by examining three questions: Is cognitive ability related to health? To what extent does it explain social inequalities in health? Do measures of socioeconomic position and cognitive ability have independent associations with health? Relative indices of inequality were used to estimate associations, using data from the Whitehall II study (baseline, 1985-1988), a British prospective cohort study (4,158 men and 1,680 women). Cognitive ability was significantly related to coronary heart disease, physical functioning, and self-rated health in both sexes and additionally to mental functioning in men. It explained some of the relation between socioeconomic position and health: 17% for coronary heart disease, 33% for physical functioning, 12% for mental functioning, and 39% for self-rated health. In analysis simultaneously adjusted for all measures of socioeconomic position, cognitive ability retained an independent association only with physical functioning in women. These results suggest that, although cognitive ability is related to health, it does not explain social inequalities in health.

Adult↗
PubMed2005

Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes.

Negative affective states such as depression are associated with premature mortality and increased risk of coronary heart disease, type 2 diabetes, and disability. It has been suggested that positive affective states are protective, but the pathways through which such effects might be mediated are poorly understood. Here we show that positive affect in middle-aged men and women is associated with reduced neuroendocrine, inflammatory, and cardiovascular activity. Positive affect was assessed by aggregating momentary experience samples of happiness over a working day and was inversely related to cortisol output over the day, independently of age, gender, socioeconomic position, body mass, and smoking. Similar patterns were observed on a leisure day. Happiness was also inversely related to heart rate assessed by using ambulatory monitoring methods over the day. Participants underwent mental stress testing in the laboratory, where plasma fibrinogen stress responses were smaller in happier individuals. These effects were independent of psychological distress, supporting the notion that positive well-being is directly related to health-relevant biological processes.

Affect↗
PubMed2005

The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms.

OBJECTIVE: To examine change in health functioning as women progress through the menopausal transition. STUDY DESIGN AND SETTING: Prospective study of 2,489 women followed through four phases of the Whitehall II study. Health functioning was assessed with the eight subscales of the SF-36. RESULTS: Compared with peri- and postmenopausal women who did not experience menopausal symptoms, women who reported vasomotor symptoms or menopausal depression experienced large and significant declines on most scales of the SF-36. Women who reported the greatest symptom severity experienced the largest declines in functioning. For example, decline in physical functioning for perimenopausal women experiencing severe vasomotor symptoms was 3.3 (standard error SE=1.1) greater than those who experienced no vasomotor symptoms. Decline in role limitation-emotional for perimenopausal women experiencing severe menopause-associated depression was 18.4 (SE=2.3), compared with those who did not experience these symptoms. Vasomotor symptom reporting was predicted by low socioeconomic position, high body mass index, and limiting long-term illness at baseline. Menopause-associated depression was additionally predicted by smoking and depression. CONCLUSION: The menopausal transition is associated with decreased health functioning in women who report menopausal symptoms. Menopausal symptoms are strongly related to all aspects of health functioning assessed by the SF-36. Socioeconomic and behavioral risk factors for menopausal symptoms and associated declines in health functioning have been identified.

Adult↗
PubMed2005

Socioeconomic position across the lifecourse: how does it relate to cognitive function in mid-life?

PURPOSE: To examine the association between socioeconomic position (SEP) over the lifecourse and cognitive function in middle age. Two alternative models were assessed: the "direct effects model" where temporally distinct measures of SEP have only direct effects on adult cognition, and the "indirect effects" model where the effect of early life SEP are mediated through later life measures of SEP. METHODS: Data are from the Whitehall II study (N=10,308 at baseline), a longitudinal cohort study of British civil servants, aged between 46 and 68 years at the time of cognitive testing. Structural equation models were used to compare the fit of direct and indirect effects models, and quantify the effects of different measures of SEP on cognition. Childhood SEP, education, and adult SEP were used to model SEP across the lifecourse. Cognitive function was assessed as a latent construct composed of the following: verbal memory, AH 4-I, Mill Hill, phonemic and semantic fluency. RESULTS: The indirect effects model provided a better fit to the data. Childhood SEP had no direct effect on cognitive function but had a substantial "indirect effect," mediated through education and adult SEP. 78.4% of the effect of education in men and 100% in women was indirect. CONCLUSIONS: Socioeconomic differences in adult cognition are a result of the socioeconomic trajectory of individuals throughout their lifecourse. Early measures of SEP influence cognition indirectly, through their influence on later measures of SEP.

Adult↗
PubMed2005

Social, behavioral, and metabolic determinants of plasma viscosity in the Whitehall II Study.

PURPOSE: To examine the social, biological, and metabolic associations of plasma viscosity in a large epidemiological study. METHODS: Plasma viscosity was measured from 4548 men and 1837 women that took part in the fifth phase of the Whitehall II Study (1997-1999). Employment grade was used as a measure of social position. RESULTS: A strong inverse relation between employment grade and plasma viscosity was evident (p < 0.0001). This employment grade gradient was apparent overall, and among non-smokers and when participants with poor health were removed from the analyses. Plasma viscosity was associated with a number of biological factors that are themselves socially determined, including fibrinogen (p < 0.001), triglycerides (p < 0.001), fasting insulin (p < 0.001), and height (p < 0.001). Associations with smoking and alcohol intake were apparent in women. In men a U-shaped curve was apparent such that those drinking between 11 and 24 units/week had the lowest plasma viscosity. Alcohol intake, physical activity, and smoking explained 18% of the grade gradient in men and 40% in women while the biological factors examined accounted for 35% in men and 40% in women. CONCLUSION: There is a grade gradient in plasma viscosity which was not fully explained by health related behaviors or measured risk factors for CHD. These data suggest that additional factors that contribute to the rheological properties of plasma may contribute to the explanation for social inequalities in cardiovascular disease.

Adult↗
PubMed2005

High blood pressure was associated with cognitive function in middle-age in the Whitehall II study.

BACKGROUND AND OBJECTIVES: Research shows elevated levels of blood pressure in midlife to be linked to impaired cognitive performance in old age. However, it remains unclear if this association extends to younger age groups. The objective of this study was to examine the association between hypertension and a range of cognitive abilities in middle aged men and women. METHODS: Data are from the Whitehall II study. Measures of blood pressure were obtained at baseline (1985-1988) and two subsequent phases of data collection (1991-1994 and 1997-1999). Cognitive function (memory test, AH 4-I, Mill-Hill, phonemic and semantic fluency) was assessed (1997-1999) when participants (N = 5,838) were aged 46-68 years old. RESULTS: Results show a small inverse association between both diastolic and systolic blood pressure and cognitive performance, independent of age, education, employment grade, smoking status, alcohol consumption, use of antihypertensive medication, diagnoses of diabetes, and cardiovascular disease. Similar associations were seen with prospective and cross-sectional analyses. The effect of hypertension was stronger in women, and stronger for cognitive measures assessing executive function. CONCLUSION: Expanding on previous studies on older participants, the present study reports a small, but significant association between hypertension and poor cognitive performance in middle-aged men and women.

Adult↗
PubMed2005

Self-reported job insecurity and health in the Whitehall II study: potential explanations of the relationship.

This paper examines the potential of demographic, personal, material and behavioural characteristics, other psychosocial features of the work environment and job satisfaction to explain associations between self-reported job insecurity and health in a longitudinal study of British white-collar civil servants. Strong associations were found between self-reported job insecurity and both poor self-rated health and minor psychiatric morbidity. After adjustment for age, employment grade and health during a prior phase of secure employment, pessimism, heightened vigilance, primary deprivation, financial security, social support and job satisfaction explained 68% of the association between job insecurity and self-rated health in women, and 36% in men. With the addition of job control, these factors explained 60% of the association between job insecurity and minor psychiatric morbidity, and just over 80% of the association with depression in both sexes.

Adult↗
PubMed2005

Impaired cardiovascular recovery following stress predicts 3-year increases in blood pressure.

OBJECTIVE: To assess whether variation in the rate of cardiovascular recovery following exposure to acute psychological stress predicts changes in blood pressure longitudinally, independently of blood pressure at baseline and other covariates. DESIGN: A 3-year longitudinal study. PARTICIPANTS: A total of 209 men and women aged 45-59 years at baseline, with no history of cardiovascular disease including hypertension. METHOD: Measurement of blood pressure, heart rate, heart rate variability, cardiac index and total peripheral resistance at rest, during two moderately stressful behavioural tasks and up to 45 min post-stress. Stress reactivity was defined as the difference in values between tasks and baseline, and post-stress recovery as the difference between recovery levels and baseline. OUTCOME MEASURES: Resting blood pressure measured at baseline and 3 years later. Seven individuals had been prescribed hypertensive medication on follow-up. RESULTS: Increases in systolic blood pressure (SBP) were predicted by impaired post-stress recovery of SBP (P < 0.001), diastolic blood pressure (DBP) (P < 0.001) and total peripheral resistance (P = 0.003), independently of baseline blood pressure, age, gender, socio-economic status, hypertensive medication, body mass and smoking. The adjusted odds of an increase in SBP > or = 5 mmHg were 3.50 [95% confidence interval (CI) 1.19 to 10.8] for individuals with poor compared with effective post-stress recovery of SBP. Three-year increases in diastolic pressure were predicted by impaired recovery of SBP (P < 0.001) and DBP (P = 0.009) pressure and by heart rate variability during tasks (P = 0.002), independently of covariates. CONCLUSIONS: Impaired post-stress recovery and less consistently heightened acute stress reactivity may index disturbances in the regulation of cardiovascular stress responses that contribute to longitudinal changes in blood pressure in middle-aged men and women.

Acute Disease↗
PubMed2005

Neighbourhood environment and its association with self rated health: evidence from Scotland and England.

OBJECTIVES: To investigate associations between measures of neighbourhood social and material environment and self rated health. DESIGN: New contextual measures added to cross sectional study of a sample of people from the Health Survey for England and the Scottish Health Survey to provide multilevel data. PARTICIPANTS: 13,899 men and women aged 16 or over for whom data on self rated health were available from the Health Survey for England (years 1994-99) and the Scottish Health Survey (years 1995 and 1998). RESULTS: Fair to very bad self rated health was significantly associated with six neighbourhood attributes: poor physical quality residential environment, left wing political climate, low political engagement, high unemployment, lower access to private transport, and lower transport wealth. Associations were independent of sex, age, social class, and economic activity. Odds ratios were larger for non-employed residents than for employed residents. Self rated health was not significantly associated with five other neighbourhood measures: public recreation facilities, crime, health service provision, access to food shops, or access to banks and buildings societies. CONCLUSIONS: Some, but not all, features of the neighbourhood environment are associated with self rated health and may be indicators of important causal pathways that could provide a focus for public health intervention strategies. Associations were more pronounced for non-employed residents, perhaps because of greater exposure to the local environment compared with employed people. Operationalizing specific measures of the characteristics of local areas hypothesised to be important for living a healthy life provides a more focused approach than general measures of deprivation in the search for area effects.

Adolescent↗
PubMed2005

Association of sleep quality and free time leisure activities in Japanese and British civil servants.

Sleep disturbance as a pervasive health problem can directly affect the physical and psychological well-being of individuals. Factors that positively relate to sleep quality can therefore improve healthy functioning. We examined whether leisure time activities are associated with sleep quality in two culturally different samples of civil servants. In this cross-sectional study we evaluated 1,682 Japanese, in Toyama prefecture (T) city, and 6,914 British civil servants from the Whitehall II study undertaken in London. The Japanese version of Pittsburgh sleep quality index (PSQI-J) was used in T city and Jenkins' sleep problem scale was used in the Whitehall II study. Setting a validated cut-off point of 5.5 for the PSQI-J global score and the upper tertile point for the Jenkins' sleep problem scale, we conducted logistic regression analysis to assess the association between leisure time activities and sleep quality. In both populations, those who participated in voluntary activities in clubs or organizations were significantly less likely to have poor sleep quality with Odds ratios (OR) and 95% confidence intervals (95%CI) of 0.73 (95%CI; 0.56-0.97) and 0.85 (95%CI; 0.76-0.95) in Japanese and British civil servants, respectively. Similar findings were apparent for visiting friends and relatives (ORs 0.60 (95%CI; 0.46-0.80) and 0.71 (95%CI; 0.56-0.90) for Japanese and British subjects, respectively). Our findings suggest that engagement in social leisure activities is associated with better sleep quality and consequently better general well-being.

Adult↗
PubMed2005

Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study.

OBJECTIVES: We examined the association between physical activity and cognitive functioning in middle age. METHODS: Data were derived from a prospective occupational cohort study of 10308 civil servants aged 35-55 years at baseline (phase 1; 1985-1988). Physical activity level, categorized as low, medium, or high, was assessed at phases 1, 3 (1991-1994), and 5 (1997-1999). Cognitive functioning was tested at phase 5, when respondents were 46-68 years old. RESULTS: In both prospective (odds ratio [OR] = 1.65; 95% confidence interval [CI]=1.30, 2.10) and cross-sectional (OR=1.79; 95% CI=1.38, 2.32) analyses, low levels of physical activity were a risk factor for poor performance on a measure of fluid intelligence. Analyses aimed at assessing cumulative effects (summary of physical activity levels at the 3 time points) showed a graded linear relationship with fluid intelligence, with persistently low levels of physical activity being particularly harmful (OR=2.21; 95% CI=1.37, 3.57). CONCLUSIONS: Low levels of physical activity are a risk factor for cognitive functioning in middle age, fluid intelligence in particular.

Adult↗
PubMed2004

Role of socialization in explaining social inequalities in health.

This paper argues that social selection, materialist/structural and cultural/behavioural explanations for social inequalities in health are related to each other through the mechanism of socialization, seen here as a process through which societies shape patterns of behaviour and being that then affect health. Socialization involves the inter- and intragenerational transfer of attitudes, beliefs and behaviours. Parallels between socialization theory and Bourdieu's concept of habitus are also drawn, and the implications for social epidemiology are discussed. Four key areas that would benefit from research within the socialization framework are identified: health behaviours, psychological vulnerability, social skills and future time perspective.

Health Status↗
PubMed2004

Prospective study of social and other risk factors for incidence of type 2 diabetes in the Whitehall II study.

BACKGROUND: Social inequalities in the incidence of type 2 diabetes and the relation of health behaviors and psychosocial factors to the incidence of type 2 diabetes are not well established. METHODS: Prospective occupational cohort study of 10 308 civil servants aged 35 to 55 years at baseline in phase 1 (1985-1988). Diagnosis of diabetes was ascertained by questionnaire at baseline and follow-up at phases 2 (1989), 3 (1992-1993), 4 (1995), and 5 (1997-1999) and glucose tolerance tests in phases 3 and 5. RESULTS: Participants working in the lower employment grades had a higher incidence of diabetes than those in higher employment grades (men: odds ratio [OR], 2.9; 95% confidence interval [CI], 1.9-4.4; women: OR, 1.7 [95% CI, 0.8-3.7]). Body mass index and other risk factors considered traditional for type 2 diabetes were found to be so in this cohort. In men, of the psychosocial risk factors examined, only effort-reward imbalance was related to incidence of diabetes (OR, 1.7 [95% CI, 1.0-2.8]). The General Health Questionnaire depression subscale was related to incidence of diabetes and impaired glucose tolerance (OR, 1.25 [95% CI, 1.0-1.6]). These associations remained after adjustment for other confounding factors. In men only, social difference in incidence of diabetes was reduced but still significant after adjustment for conventional risk factors. CONCLUSIONS: An inverse relationship exists between social position and incidence of diabetes that is partly explained by health behaviors and other risk factors. Effort-reward imbalance, which is reportedly associated with coronary heart disease, is also associated with type 2 diabetes.

Adult↗