Socioeconomic gradient in CHD in early old age

描述（由申请人提供）：Whitehall II是一项于1985年建立的纵向研究，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个假设：一个通过健康行为起作用，另一个通过社会心理因素起作用，两者都有生物中介。这些假设不需要相互竞争，因为社会心理因素可能通过对健康行为的影响与冠心病相关。另一种是通过压力系统的长期过度活动。到目前为止，我们的研究支持一个模型，从社会地位到社会心理和行为途径，到病理生理变化，疾病的亚临床标志，以及明显的冠心病。下一步将把重点从工作生活扩展到老年人群中冠心病的社会差异，并扩大概念模型的替代途径，如健康选择和遗传易感性。在过去22年中，对10 308名年龄在54-79岁之间的男女公务员进行了随访，每隔5年进行一次体检，每隔两年或三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，对于那些无法或不愿去伦敦市中心诊所的人，我们将在家中进行医学检查。随着数据的积累，我们在探索退休后冠心病社会梯度的原因方面具有独特的优势。具体目的是：(1)确定在工作生活中积累的社会心理、行为和生物风险因素是否解释了低社会群体工作后冠心病风险的增加，或者社会孤立和经济不安全感等同期因素是否更重要；(2)探讨自主神经、内分泌、代谢和炎症因素是否与社会经济地位和社会心理环境与老年早期冠心病的关系有关；(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定风险的弱势群体。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重要位置。这一早期开拓性工作的成功证明是在许多国家进行的复制研究，以及在各大洲调查从社会地位到健康的途径的研究项目。在得到科学界的认可之后，下一个障碍是让政策制定者注意到社会梯度。在这方面，Michael Marmot爵士教授鼓舞人心的努力带来了杰出的成功，最终使Michael爵士被邀请担任正在进行的世卫组织健康问题社会决定因素委员会主席。现在，在成立二十年后，白厅二世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。来自中年的丰富数据使白厅二号在阐明健康不平等的贡献以及它们在老年早期运作的机制方面处于有利地位。

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.