Social class differences in mortality, morbidity and health functioning persist in the United States, the United Kingdom and other industrialized countries. Indeed, they may be widening for mortality. Such socioeconomic status (SES) gradients in health are present throughout the lifespan persisting into the eighth decade. Changes of health with age are heterogeneous with important environmental determinants, which include SES. This project will determine patterns and determinants of change of health in relation to age and SES. Further, it will examine whether the causes and consequences of within-person changes of health with age are different from those of a single measure. In the British civil service there is an unexplained threefold higher mortality from cardiovascular disease (CVD) in the lowest compared to the highest employment grade. The broad long term objective of the Whitehall II study is to explain the socioeconomic differences in health. With the help of NIH support, the Whitehall II study of 10,308 male and female civil servants, aged 35-55 years at entry (1985-88) was established to examine the role of specific psychosocial, lifestyle, biochemical and physiological factors as possible explanations of these inequalities. True age related changes in these exposures and/or cumulative exposure measured longitudinally are hypothesized to predict changes in SES differences in health with age. Support is requested to address the following aims: 1) to describe and explain patterns of change with age in health status in relation to SES; 2) to examine potential biochemical mediators of the relation between SES, psychosocial factors and CVD; and 3) to examine the relationship between SES and change in cognitive function with age. The Whitehall II study is uniquely poised to address these questions, offering: civil service grade as an excellent measure of SES; longitudinal design with participants comparatively young at entry, allowing the detection of antecedents of change; a wide range of exposure data; repeated measures of exposures and outcomes; substantial power to detect age-related change and its interaction with SES; wide range of health outcomes including health and cognitive functioning, components of the metabolic syndrome, mortality, non-fatal diagnoses and sickness absence. This proposal requests support for data collection only, to repeat outcome measures of health functioning, cognitive functioning and components of the metabolic syndrome.
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