A prospective study of over 6500 British civil servants—the Whitehall II study—has disclosed that ill health and cardiovascular risk are as influenced by socioeconomic gradient as they were over a decade ago.

The change in gradient of employment grades between baseline and 11.1 years’ follow up for cardiovascular illness and risk factors between the highest and lowest grades was more or less similar for most of the measures. Significantly steeper gradients were seen for General Household Questionnaire score and caseness and depression in men and women and for serum cholesterol concentration in men.

Data were used from three phases of the Whitehall II study. Phase 1 (1985–8) included screening data on height, weight, blood pressure, and serum cholesterol concentration, plus self reported questionnaire data on demographic factors, work, employment grade, lifestyle. Phases 3 (1992–3) and 5 (1997–9) contributed repeat screening data and follow up questionnaire data at 5.3 years and 11.1 years, respectively. Complete data were obtained for 6770 subjects. The significance of the change in employment grade gradient was determined from the difference in regression coefficients for the gradient at the three phases tested against the null hypothesis.

The Whitehall II study was intended to clarify the link between employment grade and mortality noted in the Whitehall I study. Population data have generally indicated that socioeconomic gradient in mortality has increased. Cardiovascular studies suggested that socioeconomic differences were stable or dropping. However, they did not address trends in cardiovascular health and risk, as the Whitehall II study has.