J Epidemiol Community Health 2000;54:178-184 ( March )

Research report

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study Caroline T M van Rossum^a, Martin J Shipley^c, Hendrike van de Mheen^b, Diederick E Grobbee^d, Michael G Marmot^c

^a Department of Epidemiology and Biostatistics, Erasmus University Rotterdam, the Netherlands, ^b Department of Public Health, Erasmus University Rotterdam, ^c International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, ^d Julius Center for Patient Oriented Research, Utrecht University, the Netherlands

Correspondence to: Professor M G Marmot

Accepted for publication 14 September 1999

STUDY OBJECTIVETo test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men.
DESIGN25 year follow up of mortality in relation to employment grade.
SETTINGThe first Whitehall study.
PARTICIPANTS18 001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years.
MAIN OUTCOME MEASURESpecific causes of death.
RESULTSAfter more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases.
CONCLUSIONSDifferentials in mortality persist at older ages for almost all causes of death.


Keywords: mortality; socioeconomic factors; cause of death.

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© 2000 by Journal of Epidemiology and Community Health
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