Socioeconomic gradient in CHD in early old age

早年冠心病的社会经济梯度

• 批准号: 8318536
• 负责人: Mika J Kivimaki
• 金额: $ 34.48万
• 依托单位: UNIVERSITY COLLEGE LONDON
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8318536
• 关键词: Achievement; Address; Adult; Affect; Age; Aging; Attention; Behavioral; Biological; Biological Factors; Biological Markers; Cessation of life; Characteristics; Clinic; Communities; Complement; Coronary heart disease; Country; Data; Data Analyses; Data Collection; Disease Marker; Endocrine; Environment; Event; Exposure to; Female; Genes; Genetic; Genetic Predisposition to Disease; Health; Health behavior; Home environment; Home visitation; House Call; Inequality; Inflammation Mediators; Inflammatory; Life; London; Longitudinal Studies; Marmota; Mediator of activation protein; Metabolic; Modeling; Morbidity - disease rate; Occupational; Pathway interactions; Phase; Policy Maker; Population; Positioning Attribute; Psychosocial Factor; Questionnaires; Reporting; Research; Retirement; Risk; Risk Factors; Screening procedure; Social Mobility; Social isolation; Socioeconomic Status; Specific qualifier value; Stress; Surveys; System; Testing; Treatment/Psychosocial Effects; Variant; Vulnerable Populations; Work; aging population; cerebrovascular; cohort; data sharing; follow-up; genetic selection; genetic variant; health disparity; heart disease risk; male; medical examination; middle age; professor; programs; psychobiologic; psychosocial; social; social disparities; social group; social health determinants; socioeconomics; success

DESCRIPTION (provided by applicant): Whitehall II is a longitudinal study set up in 1985 to investigate the determinants of the social gradient in coronary heart disease (CHD). We wished to test two hypotheses regarding the causes of the social gradient: one operating via health behaviors and the other via psychosocial factors, both having biological intermediates. These hypotheses need not to be competing as one pathway by which psychosocial factors may be related to CHD is through effects on health behaviors. The other is through prolonged overactivity of the stress system. Our research to date supports a model leading from social position through psychosocial and behavioral pathways to pathophysiological changes, subclinical markers of disease, and manifest CHD. The next step will expand the focus beyond working life to social disparities in CHD in aging populations and broaden the conceptual model with alternative pathways, such as health-related selection and genetic vulnerability. Over the last 22 years, a cohort of 10,308 male and female civil servants, now at age 54-79 years, has been followed up with medical examinations at 5-year intervals and with questionnaire surveys every second or third year. Screening for the Phase 9 data collection is underway and, for those unable or unwilling to attend a clinic in central London, we will perform medical examination in the home. With the accumulating data, we are in a unique position to explore causes of the social gradient in CHD after transition to retirement. The specific aims are: (1) to determine whether cumulated exposure to psychosocial, behavioral and biological risk factors during work life explains the greater post-work CHD risk among lower social groups or whether contemporaneous factors, e.g. social isolation and financial insecurity, are more important; (2) to examine whether autonomic, endocrine, metabolic and inflammatory factors underlie the associations of socioeconomic position and the psychosocial environment with CHD in early old age; (3) to determine the extent to which social mobility in adulthood contributes to the post-work CHD gradient; and (4) to examine variants in cardiometabolic genes in order to identify groups of vulnerable people to whom a specific socioeconomic or psychosocial exposure is a particular risk. PUBLIC HEALTH RELEVANCE: Whitehall II's first major achievement was to put the social gradient in health high on the research agenda of the scientific community. Testimonies to the success of that early pioneering work are replica studies in a number of countries and research programs to investigate the pathways from social position to health in every continent. Following recognition by the scientific community, the next hurdle was to bring the social gradient to the attention of policy makers. Here the inspirational effort of Professor Sir Michael Marmot has brought outstanding success culminating in Sir Michael being asked to chair the ongoing WHO Commission on the Social Determinants of Health. Now, twenty years from its inception, Whitehall II is primed to address one of the major challenges of the new millennium; health and health disparities in an ageing population. The wealth of data from midlife places Whitehall II in pole position to elucidate the contribution of inequalities in health and the mechanisms through which they operate in early old age.

描述（由申请人提供）：Whitehall II 是一项纵向研究，成立于 1985 年，旨在调查冠心病 (CHD) 社会梯度的决定因素。我们希望检验关于社会梯度原因的两种假设：一种通过健康行为起作用，另一种通过心理社会因素起作用，两者都具有生物中间体。这些假设不必相互竞争，因为心理社会因素可能与 CHD 相关的一种途径是通过对健康行为的影响。另一种是压力系统长期过度活跃。迄今为止，我们的研究支持一个从社会地位、心理社会和行为途径到病理生理变化、疾病​​的亚临床标志物和明显的先心病的模型。下一步将把重点从工作生活扩展到老龄化人口中冠心病的社会差异，并通过替代途径（例如与健康相关的选择和遗传脆弱性）拓宽概念模型。在过去22年里，我们对年龄在54-79岁的10,308名男女公务员进行了每5年一次的体检和每两年或三年一次的问卷调查的跟踪调查。第 9 阶段数据收集的筛选正在进行中，对于那些无法或不愿意去伦敦市中心诊所的人，我们将在家中进行体检。随着数据的不断积累，我们处于独特的地位来探索退休后冠心病社会梯度的原因。具体目标是：（1）确定工作生活中累积的社会心理、行为和生物风险因素是否可以解释较低社会群体中较高的工作后冠心病风险，或者是否可以解释同时发生的因素，例如社会孤立和经济不安全更为重要； (2) 探讨自主神经、内分泌、代谢和炎症因素是否是社会经济地位和社会心理环境与早年冠心病之间关系的基础； (3) 确定成年期社会流动性对工作后冠心病梯度的影响程度； (4) 检查心脏代谢基因的变异，以确定特定社会经济或社会心理暴露对其具有特殊风险的弱势群体。公共卫生相关性：白厅二世的第一个重大成就是将健康方面的社会梯度放在科学界研究议程的重要位置。这项早期开创性工作的成功证明是在许多国家进行的复制研究和研究计划，以调查各大洲从社会地位到健康的途径。在科学界认识到这一点后，下一个障碍是让政策制定者注意到社会梯度。迈克尔·马莫特教授的鼓舞人心的努力取得了巨大的成功，最终迈克尔爵士被邀请担任正在进行的世界卫生组织健康问题社会决定因素委员会主席。如今，距白厅二号启动已有二十年了，白厅二号已准备好应对新千年的主要挑战之一；人口老龄化中的健康和健康差距。中年时期的大量数据使 Whitehall II 处于领先地位，可以阐明健康不平等的影响及其在早年发挥作用的机制。

项目成果

Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies.

• DOI: 10.2337/dc11-2055
• 发表时间: 2012-05
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Pan A;Keum N;Okereke OI;Sun Q;Kivimaki M;Rubin RR;Hu FB
• 通讯作者: Hu FB

Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts.

• DOI: 10.1371/journal.pmed.1000440
• 发表时间: 2011-06
• 期刊: PLoS medicine
• 影响因子: 15.8
• 作者: Wills AK;Lawlor DA;Matthews FE;Sayer AA;Bakra E;Ben-Shlomo Y;Benzeval M;Brunner E;Cooper R;Kivimaki M;Kuh D;Muniz-Terrera G;Hardy R
• 通讯作者: Hardy R

Antidepressant medication use, weight gain, and risk of type 2 diabetes: a population-based study.

• DOI: 10.2337/dc10-1187
• 发表时间: 2010-12
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Kivimäki M;Hamer M;Batty GD;Geddes JR;Tabak AG;Pentti J;Virtanen M;Vahtera J
• 通讯作者: Vahtera J

Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women.

• DOI: 10.2337/dc13-2936
• 发表时间: 2014-08
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Nyberg ST;Fransson EI;Heikkilä K;Ahola K;Alfredsson L;Bjorner JB;Borritz M;Burr H;Dragano N;Goldberg M;Hamer M;Jokela M;Knutsson A;Koskenvuo M;Koskinen A;Kouvonen A;Leineweber C;Madsen IE;Magnusson Hanson LL;Marmot MG;Nielsen ML;Nordin M;Oksanen T;Pejtersen JH;Pentti J;Rugulies R;Salo P;Siegrist J;Steptoe A;Suominen S;Theorell T;Väänänen A;Vahtera J;Virtanen M;Westerholm PJ;Westerlund H;Zins M;Batty GD;Brunner EJ;Ferrie JE;Singh-Manoux A;Kivimäki M;IPD-Work Consortium
• 通讯作者: IPD-Work Consortium

Job strain and the risk of inflammatory bowel diseases: individual-participant meta-analysis of 95,000 men and women.

• DOI: 10.1371/journal.pone.0088711
• 发表时间: 2014
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Heikkilä K;Madsen IE;Nyberg ST;Fransson EI;Ahola K;Alfredsson L;Bjorner JB;Borritz M;Burr H;Dragano N;Ferrie JE;Knutsson A;Koskenvuo M;Koskinen A;Nielsen ML;Nordin M;Pejtersen JH;Pentti J;Rugulies R;Oksanen T;Shipley MJ;Suominen SB;Theorell T;Väänänen A;Vahtera J;Virtanen M;Westerlund H;Westerholm PJ;Batty GD;Singh-Manoux A;Kivimäki M;IPD-Work Consortium
• 通讯作者: IPD-Work Consortium