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Employment grade and coronary heart disease in British civil servants
Insights
Job grade strongly influences coronary heart disease (CHD) mortality. Lower employment grades had significantly higher CHD mortality, even after accounting for known risk factors like smoking and blood pressure.
Area of Science:
- Occupational Health
- Cardiovascular Epidemiology
- Social Determinants of Health
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality globally.
- Socioeconomic status is known to influence health outcomes, including cardiovascular disease.
- Previous research suggests a link between employment status and health, but the specific impact of job grade on CHD mortality requires further elucidation.
Purpose of the Study:
- To investigate the relationship between employment grade, established coronary risk factors, and coronary heart disease (CHD) mortality.
- To determine the extent to which known risk factors explain the observed disparities in CHD mortality across different employment grades.
Main Methods:
- A longitudinal study design was employed.
- Data were collected from 17,530 civil servants in London.
- Follow-up duration was seven and a half years, with monitoring of CHD mortality and various health indicators.
Main Results:
- A significant inverse relationship was observed between employment grade and CHD mortality.
- Men in the lowest employment grade (messengers) exhibited 3.6 times the CHD mortality of those in the highest grade (administrators).
- Lower employment grades were associated with adverse profiles in height, weight, blood pressure, plasma glucose, smoking habits, and physical activity levels.
Conclusions:
- The higher CHD mortality in lower employment grades is only partially explained by established coronary risk factors (e.g., blood pressure, plasma glucose, smoking, physical activity, plasma cholesterol).
- Employment grade itself appears to be an independent risk factor for CHD mortality, highlighting the role of socioeconomic factors in cardiovascular health.
- Findings align with national statistics indicating higher CHD mortality among working-class populations.
Abstract:
The relationship between grade of employment, coronary risk factors, and coronary heart disease (CHD) mortality has been investigated in a longitudinal study of 17 530 civil servants working in London. After seven and a half years of follow-up there was a clear inverse relationship between grade of employment and CHD mortality. Men in the lowest grade (messengers) had 3.6 times the CHD mortality of men in the highest employment grade (administrators). Men in the lower employment grades were shorter, heavier for their height, had higher blood pressure, higher plasma glucose, smoked more, and reported less leisure-time physical activity than men in the higher grades. Yet when allowance was made for the influence on mortality of all of these factors plus plasma cholesterol, the inverse association between grade of employment and CHD mortality was still strong. It is concluded that the higher CHD mortality experienced by working class men, which is present also in national statistics, can be only partly explained by the established coronary risk factors.