Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study.

作者：George Davey Smith, Martin J Shipley, Gwen Rose · 发表于：Journal of Epidemiology & Community Health · 年份：1990 · DOI：10.1136/jech.44.4.265 · 被引用次数：384 · 研究领域：Health disparities and outcomes、Employment and Welfare Studies、Intergenerational and Educational Inequality Studies

STUDY OBJECTIVE: The aim was to explore the magnitude and causes of the differences in mortality rates according to socioeconomic position in a cohort of civil servants. DESIGN: This was a prospective observational study of civil servants followed up for 10 years after baseline data collection. SETTING: Civil service offices in London. PARTICIPANTS: 11,678 male civil servants were studied, aged 40-64 at baseline screening between 1967 and 1969. Two indices of socioeconomic position were available on these participants--employment grade (categorised into four levels), and ownership of a car. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were all cause and cause specific mortality, with cause of death taken from death certificates coded according to the eighth revision of the ICD. Employment grade and car ownership were independently related to total mortality and to mortality from the major cause groups. Combining the indices further improved definition of mortality risk and the age adjusted relative rate between the highest grade car owners and the lowest grade non-owners of 4.3 is considerably larger than the social class differentials seen in the British population. Factors potentially involved in the production of these mortality differentials were examined. Smoking, plasma cholesterol concentration, blood pressure, and glucose intolerance did not appear to account for them. The pattern of differentials was the same in the group who reported no ill health at baselin...