title: Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up.
abstract: OBJECTIVE
  To determine the impact of socioeconomic status (SES) on coronary heart disease (CHD) mortality in people with and without prevalent CHD at baseline.
  
  
  METHODS
  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.
  
  
  METHODS
  London.
  
  
  METHODS
  17 907 male civil servants aged 40-69 years.
  
  
  METHODS
  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 (lowest v 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.
authors.affiliation: International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London WC1E 6BT. h.hemingway@public-health.ucl.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
authors.forename: M
authors.initials: M
authors.lastname: Shipley
authors.forename: P
authors.initials: P
authors.lastname: Macfarlane
authors.forename: M
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D004562:Electrocardiography / Q000401:mortality; D005500:Follow-Up Studies; D006076:Government; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires