Socioeconomic gradient in CHD in early old age

描述（由申请人提供）：白厅II是一项纵向研究，成立于1985年，旨在调查冠心病（CHD）的社会梯度的决定因素。我们希望测试两个假设的社会梯度的原因：一个通过健康行为和其他通过心理社会因素，都有生物中介。这些假设不需要相互竞争，因为心理社会因素可能与CHD相关的一个途径是通过对健康行为的影响。另一种是通过长期过度活跃的压力系统。迄今为止，我们的研究支持一种模型，该模型从社会地位通过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CHD。下一步将把重点从工作生活扩展到老年人群中CHD的社会差异，并扩大概念模型的替代途径，如健康相关的选择和遗传脆弱性。在过去的22年里，对10 308名年龄在54-79岁之间的男女公务员进行了跟踪调查，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。9期数据收集的筛选正在进行中，对于那些不能或不愿意参加伦敦中心诊所的患者，我们将在家中进行医学检查。随着数据的积累，我们处于一个独特的位置，以探索社会梯度的原因，在冠心病后过渡到退休。具体目标是：（1）确定在工作生活中累积暴露于心理社会，行为和生物风险因素是否解释了较低社会群体中更大的工作后CHD风险，或者同时因素，例如社会隔离和经济不安全感是否更重要;（2）检查是否有自主神经、内分泌、代谢和炎症因子是社会经济地位和心理社会环境与老年早期冠心病相关性的基础;（3）确定成年后社会流动性对工作后CHD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心理社会暴露的弱势人群。公共卫生相关性：白厅二世的第一个主要成就是将健康的社会梯度放在科学界研究议程的首位。这一早期开创性工作的成功证明是在一些国家进行的复制研究和调查各大洲从社会地位到健康的途径的研究方案。在科学界认识到这一点之后，下一个障碍是使决策者注意到社会梯度。在这方面，Michael Marmot爵士教授的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卫生组织健康问题社会决定因素委员会主席。现在，距离成立已有20年，白厅II准备应对新千年的主要挑战之一：老龄化人口的健康和健康差距。来自中年的大量数据使白厅二号站在了阐明健康不平等的作用及其在老年早期运作的机制的最佳位置。

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.