DO SOCIOECONOMIC DIFFERENCES IN MORTALITY PERSIST AFTER RETIREMENT - 25 YEAR FOLLOW-UP OF CIVIL-SERVANTS FROM THE FIRST WHITEHALL STUDY

Objective-To assess the risk of death associated with work based and n on-work based measures of socioeconomic status before and after retire ment age. Design-Follow up study of mortality in relation to employmen t grade and car ownership over 25 years. Setting-The first Whitehall s tudy. Subjects-18 133 male civil servants aged 40-69 years who attende d a screening examination between 1967 and 1970. Main outcome measure- Death. Results-Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40-64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidenc e interval 2.4 to 4.1). After retirement the ability of grade to predi ct mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality le ss well than employment grade before retirement but its ability to pre dict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconom ic groups showed employment grade and car ownership to have independen t associations with mortality that were of equal magnitude after retir ement. The absolute difference in death rates between the lowest and h ighest employment grades increased with age from 12.9 per 1000 person years at ages 40-64 to 38.3 per 1000 at ages 70-89. Conclusions-Socioe conomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based o n an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an im portant part in generating social inequalities in health in men of wor king age.