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  • Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up

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Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up
  1. Harry Hemingwaya,b,
  2. Martin Shipleya,
  3. Peter Macfarlanec,
  4. Michael Marmota
  1. aInternational Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, bDepartment of Research and Development, Kensington and Chelsea and Westminster Health Authority, London, cUniversity of Glasgow, Department of Medical Cardiology, Royal Infirmary, Glasgow
  1. Dr Hemingway (h.hemingway{at}public-health.ucl.ac.uk)

Abstract

OBJECTIVES To determine the impact of socioeconomic status (SES) on coronary heart disease (CHD) mortality in people with and without prevalent CHD at baseline.

DESIGN Cohort study with 25 year follow up; prevalent CHD was defined by Q, ST or T wave electrocardiographic (ECG) abnormalities or symptoms (defined by the Rose chest pain questionnaire and self reported doctor diagnosis) or both. SES was defined by four civil service employment grades.

SETTING London.

PARTICIPANTS 17 907 male civil servants aged 40–69 years.

MAIN OUTCOME MEASURES CHD mortality (n=2695 deaths).

RESULTS The lowest versus highest employment grade was associated with increased CHD mortality (age adjusted hazard ratio 1.56 (95% CI 1.2, 2.1)), prevalence of symptoms and, among symptomatic participants only, the prevalence of Q, ST or T abnormalities. Thirty one per cent of CHD deaths occurred in participants with prevalent CHD at baseline. Among participants without Q, ST or T abnormality employment grade was associated with CHD mortality; the hazard ratios (lowestv highest grade) adjusted for age, systolic and diastolic blood pressure were 1.72 (95% CI 1.4, 2.1) for asymptomatic and 1.52 (95% CI 1.1, 2.1) for symptomatic participants; among participants with Q, ST or T abnormality the corresponding hazard ratios were 1.46 (95% CI 0.7, 2.9) and 1.14 (95% CI 0.6, 2.0) respectively.

CONCLUSIONS SES was inversely associated with CHD mortality in civil servants with and without prevalent CHD at baseline. Further distinguishing the relative contribution of SES to the initiation and progression of CHD requires repeated measures studies of pre-clinical and clinical measures of CHD.

  • socioeconomic status
  • coronary mortality

https://doi.org/10.1136/jech.54.7.510

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    Footnotes

    • Funding: MM is supported by an MRC Research Professorship. MS is supported by the British Heart Foundation.

    • Conflicts of interest: none