Unfairness and health: evidence from the Whitehall II Study.
OBJECTIVE
To examine the effects of unfairness on incident coronary events and health functioning.


METHODS
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.


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


METHODS
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.
De Vogli
Roberto
R
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@ucl.ac.uk
Ferrie
Jane E
JE
Chandola
Tarani
T
Kivimäki
Mika
M
Marmot
Michael G
MG
D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D004651:Employment; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D007398:Interpersonal Relations; D008131:London / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D016016:Proportional Hazards Models; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology / Q000523:psychology