Article Text

Download PDFPDF
Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study
  1. M Marmot,
  2. M Shipley,
  3. E Brunner,
  4. H Hemingway
  1. International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
  1. Professor Marmot (M.Marmot{at}


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.

  • early life
  • socioeconomic status
  • coronary heart disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive US, NIH National Heart Lung and Blood Institute (RO1-HL36310); US, NIH National Institute on Aging (RO1-AG13196); US, NIH Agency for Health Care Policy Research (RO1-HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Socio-economic Status and Health. MM is supported by an MRC Research Professorship; MS and EB are supported by the British Heart Foundation.

  • Conflicts of interest: none