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Unfairness and health: evidence from the Whitehall II Study
  1. Roberto De Vogli1,
  2. Jane E Ferrie1,
  3. Tarani Chandola1,
  4. Mika Kivimäki2,
  5. Michael G Marmot1
  1. 1Department of Epidemiology and Public Health, International Institute for Society and Health, University College London, London, UK
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  1. Correspondence to:
 Dr R De Vogli
 Department of Epidemiology and Public Health, International Institute for Society and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; r.devogli{at}


Objective: To examine the effects of unfairness on incident coronary events and health functioning.

Design: Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort–reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow-up of 10.9 years.

Participants: 5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study).

Main outcome measures: Incident fatal coronary heart disease, non-fatal myocardial infarction and angina (528 events) and health functioning.

Results: Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work-related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline.

Conclusions: Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease.

  • CHD, coronary heart disease
  • MI, myocardial infarction
  • SF-36, Short-Form 36 Health Survey

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  • RDV with JEF, TC, MK designed the hypothesis, analysed the data and wrote the paper. MGM reviewed the drafts of the paper and he is the director of the Whitehall II Study.

  • Funding: The Whitehall II Study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health. RDV is supported by the National Institute on Aging. JEF is supported by the MRC (Grant number G8802774), and MGM by an MRC Research Professorship.

  • Competing interests: None.

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