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Socioeconomic Differences in Cardiometabolic Factors: Social Causation or Health-related Selection? Evidence From the Whitehall II Cohort Study, 1991–2004

Elovainio, M; Ferrie, JE; Singh-Manoux, A; Shipley, M; Batty, GD; Head, J; Hamer, M; ... Kivimäki, M; + view all (2011) Socioeconomic Differences in Cardiometabolic Factors: Social Causation or Health-related Selection? Evidence From the Whitehall II Cohort Study, 1991–2004. American Journal of Epidemiology , 174 (7) pp. 779-789. 10.1093/aje/kwr149. Green open access

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Abstract

In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P’s ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P’s ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.

Type: Article
Title: Socioeconomic Differences in Cardiometabolic Factors: Social Causation or Health-related Selection? Evidence From the Whitehall II Cohort Study, 1991–2004
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/aje/kwr149
Publisher version: http://dx.doi.org/10.1093/aje/kwr149
Language: English
Additional information: American Journal of Epidemiology, copyright © The Author 2011. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: cardiovascular diseases, health status disparities, longitudinal studies, metabolic syndrome X, public health, social class
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/1319408
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