Diagnosis-specific sick leave as a long-term predictor of disability pension: a 13-year follow-up of the GAZEL cohort study.

BACKGROUND: Factors that increase the risk of labour market exclusion are poorly understood. In this study, we examined the extent to which all-cause and diagnosis-specific sick leave predict subsequent disability pension (DP). METHODS: Prospective cohort study of 20 434 persons employed by the French national gas and electric company (the GAZEL study). New sick-leave spells >7 days in 1990-1992 were obtained from company records. Follow-up for DP was from 1994 to 2007. RESULTS: The HR, adjusted for age and occupational position, for DP was 3.5 (95% CI 2.7 to 4.5) in men and 2.6 (95% CI 1.9 to 3.5) in women with one or more sick-leave spells >7 days compared with those with no sick leave. The strongest predictor of DP was sick leave with a psychiatric diagnosis, HR 7.6 (95% CI 5.2 to 10.9) for men and 4.1 (95% CI 2.9 to 5.9) for women. Corresponding HRs for sick leave due to circulatory diagnoses in men and women were 5.6 (95% CI 3.7 to 8.6) and 3.1 (95% CI 1.8 to 5.3), for respiratory diagnoses 3.9 (95% CI 2.6 to 5.8) and 2.6 (95% CI 1.7 to 4.0), and musculoskeletal diagnoses 4.6 (95% CI 3.4 to 6.4) and 3.3 (95% CI 2.2 to 4.8), respectively. CONCLUSIONS: Sick leave with a psychiatric diagnosis is a major risk factor for subsequent DP, especially among men. Sick leave due to musculoskeletal or circulatory disorders was also a strong predictor of DP. Diagnosis-specific sick leave should be recognised as an early risk marker for future exclusion from the labour market.

The association of cognitive performance with mental health and physical functioning strengthens with age: the Whitehall II cohort study.

BACKGROUND: Cognitive performance has been associated with mental and physical health, but it is unknown whether the strength of these associations changes with ageing and with age-related social transitions, such as retirement. We examined whether cognitive performance predicted mental and physical health from midlife to early old age. METHOD: Participants were 5414 men and 2278 women from the Whitehall II cohort study followed for 15 years between 1991 and 2006. The age range included over the follow-up was from 40 to 75 years. Mental health and physical functioning were measured six times using SF-36 subscales. Cognitive performance was assessed three times using five cognitive tests assessing verbal and numerical reasoning, verbal memory, and phonemic and semantic fluency. Socio-economic status (SES) and retirement were included as covariates. RESULTS: High cognitive performance was associated with better mental health and physical functioning. Mental health differences associated with cognitive performance widened with age from 39 to 76 years of age, whereas physical functioning differences widened only between 39 and 60 years and not after 60 years of age. SES explained part of the widening differences in mental health and physical functioning before age 60. Cognitive performance was more strongly associated with mental health in retired than non-retired participants, which contributed to the widening differences after 60 years of age. CONCLUSIONS: The strength of cognitive performance in predicting mental and physical health may increase from midlife to early old age, and these changes may be related to SES and age-related transitions, such as retirement.

When do social inequalities in C-reactive protein start? A life course perspective from conception to adulthood in the Cardiovascular Risk in Young Finns Study.

BACKGROUND: It is unclear when in the life course do social inequalities in inflammation emerge. We examined whether the association between socioeconomic position (SEP) and C-reactive protein (CRP) is determined at conception, in childhood, adolescence or adulthood in 1484 participants from the population-based Cardiovascular Risk in Young Finns Study. METHODS: Five variants of the CRP gene were used to investigate whether SEP differences in CRP levels are determined at conception. SEP and serum CRP were assessed in childhood (age 3-9), adolescence (age 12-18) and in adulthood (age 24-39). SEP was measured using parental education and occupational status in childhood and adolescence, and participants' own education and occupational status in adulthood. Participants with CRP > 10 mg/l were excluded. RESULTS: All CRP gene variants were associated with circulating CRP concentrations in childhood, but there were no differences in the distribution of these variants by SEP. No strong evidence was found of associations between parental SEP and CRP. A graded association between higher SEP and lower CRP was observed in adulthood for education (P = 0.0005) but not for occupational status. Trajectories that led to high educational achievement both in the participants and their parents were associated with lower (P

Socioeconomic gradients in cardiorespiratory disease and diabetes in the 1960s: baseline findings from the GPO study.

OBJECTIVES: To describe the socioeconomic distribution of risk factors for cardiorespiratory disease and diabetes in employed women and men in the late 1960s. STUDY DESIGN AND METHODS: Cross-sectional data were collected from 3345 General Post Office (GPO) employees in London, via a questionnaire and clinical examination, between October 1966 and April 1967. RESULTS: Our occupational grade classification conformed to expected patterns of greater car ownership and gardening among higher-grade women and men, and greater height in higher-grade men (highest-lowest grade 175.0-170.7 cm, P<0.001). A strong inverse grade gradient in bronchitis (2.1-9.4%, P<0.001) and a strong positive gradient in FEV1 (3.10-2.58l, P<0.001) were observed in men, although smoking was less consistently associated with grade. There was no consistent inverse association between grade and any cardiovascular risk factor in either sex, but strong inverse gradients in prevalence of impaired glucose tolerance (IGT) (5.1-18.2%, P<0.001) and 2-h glucose (4.14-4.25 mmol/l, P<0.001) in non-diabetic men. Using car ownership as an alternative measure of socioeconomic position, findings in men were replicated for respiratory measures, IGT and 2-h glucose prevalence. Inverse gradients were additionally observed for blood pressure, cholesterol and electrocardiogram abnormalities. CONCLUSIONS: The GPO study confirms existing evidence of socioeconomic gradients in respiratory risk factors and provides new evidence of gradients in risk factors for diabetes in men. Although there was no conclusive evidence of an occupational gradient in any cardiovascular risk factor, car ownership was a good indicator of lower risk in men. No socioeconomic gradients in cardiorespiratory or diabetic risk factors were observed in women.

Socioeconomic position in childhood and adult cardiovascular risk factors, vascular structure, and function: cardiovascular risk in young Finns study.

OBJECTIVE: To examine the association of childhood socioeconomic position (SEP) with adult cardiovascular risk factors, vascular structure, and vascular function in a contemporary population of young adults. DESIGN: Population based prospective cohort study with baseline assessment in 1980. SETTING: Finland. PARTICIPANTS: 856 men and 1066 women whose childhood SEP was determined by parental occupational status (manual, lower non-manual, upper non-manual) at age 3-18 years. MAIN OUTCOME MEASURES: Cardiovascular risk factors, carotid artery intima-media thickness, and brachial artery flow mediated vasodilatation, assessed at age 24-39 years. RESULTS: After adjustment for age and adult SEP, systolic pressure was 2.3 mm Hg higher (p = 0.0002), high density lipoprotein (HDL) cholesterol 0.03 mmol/l lower (p = 0.02), and insulin resistance score (homeostasis model assessment index) 0.12 units greater (p = 0.05) among men; and systolic pressure was 1.3 mm Hg higher (p = 0.02), diastolic pressure 1.1 mm Hg higher (p = 0.01), and height 1.1 cm lower (p < 0.0001) among women for each step down the childhood SEP hierarchy. Lower childhood SEP was associated with a 20% increase in the odds of having a waist circumference > 102 cm in men and > 88 cm in women (overall p = 0.05). Childhood SEP was not associated with intima-media thickness, flow mediated vasodilatation, the metabolic syndrome, low density lipoprotein cholesterol, triglycerides, body mass index, alcohol consumption, or smoking. CONCLUSIONS: Among adults under 40, low childhood SEP predicted higher blood pressure and central obesity and, among men, unfavourable HDL cholesterol and insulin resistance, independent of current SEP. No independent effects were found on adult vascular structure, vascular function, or health related behaviours at this life stage.

Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study.

BACKGROUND: Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors. METHODS: The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination. RESULTS: Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%. CONCLUSION: We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.

Organisational justice and health of employees: prospective cohort study.

AIMS: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees. METHODS: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998-2000 in 10 hospitals in Finland. RESULTS: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality). CONCLUSIONS: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

Change in health inequalities among British civil servants: the Whitehall II study.

STUDY OBJECTIVE: Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants. DESIGN: Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared. SETTING: Whitehall II, prospective cohort study. PARTICIPANTS: White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases. RESULTS: Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01). CONCLUSIONS: There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.