Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study

Study objective-To determine the relative contribution of adult compared wi th early life socioeconomic status as predictors of morbidity attributable to coronary heart disease (CHD), chronic bronchitis and depression in the W hitehall ii study of British civil servants. Design-Prospective observational study with mean 5.3 years (range 3.7-7.6) follow up. Setting-20 civil service departments originally located in London. Participants-6895 male and 3413 female office-based civil servants aged 35- 55 years at baseline. Outcome measures-New cases at follow up of CHD, chronic bronchitis and depr ession defined using validated questionnaires. Main results-Employment grade was inversely associated with CHD, chronic br onchitis and depression in men (odds ratio per unit decrease in grade 1.30, 1.44 and 1.20 respectively). Employment grade was strongly related to fath er's social class. Chronic bronchitis, in women, and depression, in men, we re more common among those with fathers of higher social class. When mutual adjustment was made for father's social class, grade at entry to the civil service and current grade, the strongest effects on adult morbidity were f ound for current grade. Among participants in whom neither parent had died less than or equal to 70 years of age the inverse association with adult SE S was maintained. Conclusions-Adult socioeconomic status was a more important predictor of mo rbidity attributable to coronary disease, chronic bronchitis and depression than measures of social status earlier in life. In this population, the im portance of social circumstances early in life may be in the way they influ ence employment and social position and thus exposures in adult life.