title: Change in health inequalities among British civil servants: the Whitehall II study.
abstract: OBJECTIVE
  Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants.
  
  
  METHODS
  Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared.
  
  
  METHODS
  Whitehall II, prospective cohort study.
  
  
  METHODS
  White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases.
  
  
  RESULTS
  Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01).
  
  
  CONCLUSIONS
  There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.
authors.affiliation: International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, UK. j.ferrie@public-health.ucl.ac.uk
authors.forename: J E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: M J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: G
authors.initials: G
authors.lastname: Davey Smith
authors.forename: S A
authors.initials: SA
authors.lastname: Stansfeld
authors.forename: M G
authors.initials: MG
authors.lastname: Marmot
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006076:Government; D006304:Health Status; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D016272:Occupational Health; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors