title: Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991-2004.
abstract: In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P's ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P's ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.
authors.affiliation: Department of Epidemiology and Public Health, UCL Medical School, University College London, United Kingdom. marko.elovainio@thl.fi
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Martin
authors.initials: M
authors.lastname: Shipley
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Eric
authors.initials: E
authors.lastname: Brunner
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D015984:Causality; D002648:Child; D015331:Cohort Studies; D004651:Employment / Q000145:classification; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008077:Lipoproteins, LDL / Q000097:blood; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008077:Lipoproteins, LDL