Socioeconomic gradient in CHD in early old age

描述(由申请者提供)：白厅II是一项成立于1985年的纵向研究，目的是调查冠心病(CHD)社会梯度的决定因素。我们希望测试两个关于社会梯度原因的假设：一个通过健康行为起作用，另一个通过心理社会因素起作用，两者都有生物中介。这些假说不需要相互竞争，因为心理社会因素可能通过影响健康行为与CHD相关。另一个原因是应激系统长期过度活动。到目前为止，我们的研究支持一个模型，该模型从社会地位通过心理社会和行为途径引导到病理生理变化、疾病的亚临床标记物和明显的冠心病。下一步将把重点从工作生活扩大到老年人口中冠心病的社会差异，并通过与健康相关的选择和遗传脆弱性等替代途径拓宽概念模型。在过去22年中，10,308名男女公务员，年龄在54岁至79岁之间，每隔5年进行一次体检，每隔2年或3年进行一次问卷调查。第九阶段数据收集的筛查正在进行中，对于那些不能或不愿意去伦敦市中心的诊所的人，我们将在家里进行体检。随着数据的积累，我们在探索冠心病向退休过渡后社会梯度的原因方面处于独特的地位。具体目标是：(1)确定在工作生活中累积暴露于心理社会、行为和生物危险因素是否解释了较低社会群体中较大的工作后冠心病风险，或者是否同时代因素，如社会孤立和经济不安全感，更重要；(2)检查自主、内分泌、代谢和炎症因素是否奠定了社会经济地位和心理社会环境与老年早期冠心病的关联；(3)确定成年后社会流动性对工作后冠心病梯度的影响程度；以及(4)检查心脏代谢基因的变异，以确定特定社会经济或心理社会暴露对其具有特殊风险的弱势群体。公共卫生相关性：白厅II的第一个主要成就是将健康方面的社会梯度放在科学界研究议程的优先位置。早期开创性工作取得成功的证据是在一些国家进行的复制品研究，以及在每个大洲调查从社会地位到健康的途径的研究计划。在得到科学界的承认之后，下一个障碍是使社会梯度引起政策制定者的注意。在这方面，迈克尔·马尔莫特爵士鼓舞人心的努力取得了巨大成功，最终迈克尔爵士被邀请担任世卫组织健康的社会决定因素委员会的主席。现在，在白厅二号成立20年后，它已经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。来自中年的丰富数据使怀特霍尔二世在阐明健康不平等的贡献以及它们在早年发挥作用的机制方面处于领先地位。

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.