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  • Socioeconomic inequality in recovery from poor physical and mental health in mid-life and early old age: prospective Whitehall II cohort study

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Inequalities
Socioeconomic inequality in recovery from poor physical and mental health in mid-life and early old age: prospective Whitehall II cohort study
  1. Akihiro Tanaka1,2,
  2. Martin J Shipley1,
  3. Catherine A Welch1,
  4. Nora E Groce1,
  5. Michael G Marmot1,
  6. Mika Kivimaki1,
  7. Archana Singh-Manoux1,3,
  8. Eric J Brunner1
  1. 1 Department of Epidemiology and Public Health, University College London, London, UK
  2. 2 Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
  3. 3 INSERM U1018, Université Paris-Saclay, Villejuif, France
  1. Correspondence to Dr Eric J Brunner, UCL Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; e.brunner{at}ucl.ac.uk

Abstract

Background Few studies have examined the influence of socioeconomic status on recovery from poor physical and mental health.

Methods Prospective study with four consecutive periods of follow-up (1991–2011) of 7564 civil servants (2228 women) recruited while working in London. Health was measured by the Short-Form 36 questionnaire physical and mental component scores assessed at beginning and end of each of four rounds. Poor health was defined by a score in the lowest 20% of the age–sex-specific distribution. Recovery was defined as changing from a low score at the beginning to a normal score at the end of the round. The analysis took account of retirement status, health behaviours, body mass index and prevalent chronic disease.

Results Of 24 001 person-observations in the age range 39–83, a total of 8105 identified poor physical or mental health. Lower grade of employment was strongly associated with slower recovery from poor physical health (OR 0.73 (95% CI 0.59 to 0.91); trend P=0.002) in age, sex and ethnicity-adjusted analyses. The association was halved after further adjustment for health behaviours, adiposity, systolic blood pressure (SBP) and serum cholesterol (OR 0.85 (0.68 to 1.07)). In contrast, slower recovery from poor mental health was associated robustly with low employment grade even after multiple adjustment (OR 0.74 (0.59 to 0.93); trend P=0.02).

Conclusions Socioeconomic inequalities in recovery from poor physical health were explained to a considerable extent by health behaviours, adiposity, SBP and serum cholesterol. These risk factors explained only part of the gradient in recovery for poor mental health.

  • mental health
  • ageing
  • inequalities
  • cohort studies
  • functioning and disability

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/jech-2017-209584

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    Footnotes

    • Contributors EJB and MJS designed the study. AT conducted the initial analysis and drafted the paper. CAW and MJS completed the analysis. NEG, MGM, MK and AS-M commented on the draft paper.

    • Funding The Whitehall II study is supported by grants from the UK Medical Research Council (MRC K013351), British Heart Foundation (BHF RG/16/11/32334) and the US National Institutes on Aging (R01AG013196; R01AG034454).

    • Competing interests EJB is supported by the BHF (RG/16/11/32334) and the European Commission (FP7 project no. 613598). MK is supported by the MRC (K013351) and NordForsk, the Nordic Programme on Health and Welfare.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the University College London Medical School Committee on the ethics of human research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Whitehall II data, protocols and other metadata are available to bona fide researchers for research purposes. Please refer to the Whitehall II data sharing policy at http://www.ucl.ac.uk/whitehallII/data-sharing.