Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study

Abstract

STUDY OBJECTIVE To determine the relative contribution of adult compared with early life socioeconomic status as predictors of morbidity attributable to coronary heart disease (CHD), chronic bronchitis and depression in the Whitehall II study of British civil servants.

DESIGN Prospective observational study with mean 5.3 years (range 3.7–7.6) follow up.

SETTING 20 civil service departments originally located in London.

PARTICIPANTS 6895 male and 3413 female office-based civil servants aged 35–55 years at baseline.

OUTCOME MEASURES New cases at follow up of CHD, chronic bronchitis and depression defined using validated questionnaires.

MAIN RESULTS Employment grade was inversely associated with CHD, chronic bronchitis and depression in men (odds ratio per unit decrease in grade 1.30, 1.44 and 1.20 respectively). Employment grade was strongly related to father's social class. Chronic bronchitis, in women, and depression, in men, were more common among those with fathers of higher social class. When mutual adjustment was made for father's social class, grade at entry to the civil service and current grade, the strongest effects on adult morbidity were found for current grade. Among participants in whom neither parent had died ≤70 years of age the inverse association with adult SES was maintained.

CONCLUSIONS Adult socioeconomic status was a more important predictor of morbidity attributable to coronary disease, chronic bronchitis and depression than measures of social status earlier in life. In this population, the importance of social circumstances early in life may be in the way they influence employment and social position and thus exposures in adult life.