RESEARCH REPORT

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

J E Ferrie¹, M J Shipley¹, G Davey Smith², S A Stansfeld³ and M G Marmot¹

¹ International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK
² Department of Social Medicine, University of Bristol, Bristol, UK
³ Department of Psychiatry, Queen Mary University of London, London, UK

Correspondence to:
Correspondence to:
Jane Ferrie, Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK;
j.ferrie{at}public-health.ucl.ac.uk

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.

Keywords: health inequalities; longitudinal study

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