Change in employment status and health in white collar workers

Restructuring and widespread workplace closures have exposed white-collar workers to unprecedented levels of job insecurity and unemployment. This thesis describes two studies which examined effects on health of job insecurity and job loss in a longitudinal study of 10,308 white-collar British civil servants. Study 1 examined the consequences of short and long-term job insecurity generated by the transfer of work to agencies which were periodically under threat of privatisation. Relative to unaffected controls, self-reported morbidity increased significantly among respondents expecting transfer to an agency. Physiological measurements, such as blood pressure and body mass index, deteriorated significantly among respondents working in an agency. Increases in morbidity were greater in men than women. Study 2 examined the effects of job insecurity and job loss for respondents in one complete Civil Service department sold to the private sector. Data from three time points were analysed: 2 years pre-privatisation (anticipation phase); 3 months pre-privatisation (pre-termination phase); and 1.5 years post-privatisation. During the anticipation phase, compared with controls, respondents from the department undergoing privatisation experienced an overall increase in self-reported morbidity. By the pre-termination phase adverse changes were also seen in physiological measures. Postprivatisation, respondents were stratified by employment status. Overall, respondents in secure employment enjoyed better self-reported health than those in any other group. Unemployed men and insecurely employed women had the poorest self-reported health. Psychological disorder was significantly associated with insecure employment in both sexes and unemployment in men. Some evidence of health selection out of the workforce was found, but adjustment for pre-existing morbidity demonstrated adverse effects on health in excess of those attributable to selection. Changes in work characteristics and health-related behaviours explained little of the effect of employment status on health. Further research on the employment status-health relationship is required

Long-term adherence to healthy dietary guidelines and chronic inflammation in the prospective Whitehall II study

Background Inflammation plays an important role in the cause of cardiovascular diseases and may contribute to the association linking an unhealthy diet to chronic age-related diseases. However, to date the long-term associations between diet and inflammation have been poorly described. Our aim was to assess the extent to which adherence to a healthy diet and dietary improvements over a 6-year exposure period prevented subsequent chronic inflammation over a 5-year follow-up in a large British population of men and women. Methods Data were drawn from 4600 adults (mean ± standard deviation, age 49.6 ± 6.1 years, 28% were women) from the prospective Whitehall cohort II study. Adherence to a healthy diet was measured using Alternative Healthy Eating Index (AHEI) scores in 1991-1993 (50.7 ± 11.9 points) and 1997-1999 (51.6 ± 12.4 points). Chronic inflammation, defined as average levels of serum interleukin-6 from 2 measures 5 years apart, was assessed in 1997-1999 and 2002-2004. Results After adjustment for sociodemographic factors, health behaviors, and health status, participants who maintained a high AHEI score (ie, a healthy diet, n = 1736, 37.7%) and those who improved this score over time (n = 681, 14.8%) showed significantly lower mean levels of interleukin-6 (1.84 pg/mL, 95% confidence interval [CI], 1.71-1.98 and 1.84 pg/mL, 95% CI, 1.70-1.99, respectively) than those who had a low AHEI score (n = 1594, 34.6%) over the 6-year exposure period (2.01 pg/mL, 95% CI, 1.87-2.17). Conclusions These data suggest that maintaining and improving adherence to healthy dietary recommendations may reduce the risk of long-term inflammation.</p

The Joint Effect of Sleep Duration and Disturbed Sleep on Cause-Specific Mortality: Results from the Whitehall II Cohort Study

Background: Both sleep duration and sleep quality are related to future health, but their combined effects on mortality are unsettled. We aimed to examine the individual and joint effects of sleep duration and sleep disturbances on cause-specific mortality in a large prospective cohort study. Methods: We included 9,098 men and women free of pre-existing disease from the Whitehall II study, UK. Sleep measures were self-reported at baseline (1985-1988). Participants were followed until 2010 in a nationwide death register for total and cause-specific (cardiovascular disease, cancer and other) mortality. Results: There were 804 deaths over a mean 22 year follow-up period. In men, short sleep (≤6 hrs/night) and disturbed sleep were not independently associated with CVD mortality, but there was an indication of higher risk among men who experienced both (HR = 1.57; 95% CI: 0.96-2.58). In women, short sleep and disturbed sleep were independently associated with CVD mortality, and women with both short and disturbed sleep experienced a much higher risk of CVD mortality (3.19; 1.52-6.72) compared to those who slept 7-8 hours with no sleep disturbances; equivalent to approximately 90 additional deaths per 100,000 person years. Sleep was not associated with death due to cancer or other causes. Conclusion: Both short sleep and disturbed sleep are independent risk factors for CVD mortality in women and future studies on sleep may benefit from assessing disturbed sleep in addition to sleep duration in order to capture health-relevant features of inadequate sleep. © 2014 Rod et al

Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study

Objective To investigate whether knowing the diagnosis for sickness absence improves prediction of mortality

Gender-specific associations of short sleep duration with prevalent and incident hypertension : the Whitehall II Study

Sleep deprivation (5 hour per night) was associated with a higher risk of hypertension in middle-aged American adults but not among older individuals. However, the outcome was based on self-reported diagnosis of incident hypertension, and no gender-specific analyses were included. We examined cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension in a cohort of 10 308 British civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). Data were gathered from phase 5 (1997-1999) and phase 7 (2003-2004). Sleep duration and other covariates were assessed at phase 5. At both examinations, hypertension was defined as blood pressure 140/90 mm Hg or regular use of antihypertensive medications. In cross-sectional analyses at phase 5 (n5766), short duration of sleep (5 hour per night) was associated with higher risk of hypertension compared with the group sleeping 7 hours, among women (odds ratio: 2.01; 95% CI: 1.13 to 3.58), independent of confounders, with an inverse linear trend across decreasing hours of sleep (P0.003). No association was detected in men. In prospective analyses (mean follow-up: 5 years), the cumulative incidence of hypertension was 20.0% (n740) among 3691 normotensive individuals at phase 5. In women, short duration of sleep was associated with a higher risk of hypertension in a reduced model (age and employment) (6 hours per night: odds ratio: 1.56 [95% CI: 1.07 to 2.27]; 5 hour per night: odds ratio: 1.94 [95% CI: 1.08 to 3.50] versus 7 hours). The associations were attenuated after accounting for cardiovascular risk factors and psychiatric comorbidities (odds ratio: 1.42 [95% CI: 0.94 to 2.16]; odds ratio: 1.31 [95% CI: 0.65 to 2.63], respectively). Sleep deprivation may produce detrimental cardiovascular effects among women. (Hypertension. 2007;50:694-701.) Key Words: sleep duration blood pressure hypertension gender differences confounders comorbiditie

Change in Sleep Duration and Type 2 Diabetes: The Whitehall II Study

OBJECTIVE Evidence suggests that short and long sleep durations are associated with a higher risk of type 2 diabetes. Using successive data waves spanning &amp;gt;20 years, we examined whether a change in sleep duration is associated with incident diabetes. RESEARCH DESIGN AND METHODS Sleep duration was reported at the beginning and end of four 5-year cycles: 1985–1988 to 1991–1994 (n = 5,613), 1991–1994 to 1997–1999 (n = 4,193), 1997–1999 to 2002–2004 (n = 3,840), and 2002–2004 to 2007–2009 (n = 4,195). At each cycle, change in sleep duration was calculated for participants without diabetes. Incident diabetes at the end of the subsequent 5-year period was defined using 1) fasting glucose, 2) 75-g oral glucose tolerance test, and 3) glycated hemoglobin, in conjunction with diabetes medication and self-reported doctor diagnosis. RESULTS Compared with the reference group of persistent 7-h sleepers, an increase of ≥2 h sleep per night was associated with a higher risk of incident diabetes (odds ratio 1.65 [95% CI 1.15, 2.37]) in analyses adjusted for age, sex, employment grade, and ethnic group. This association was partially attenuated by adjustment for BMI and change in weight (1.50 [1.04, 2.16]). An increased risk of incident diabetes was also seen in persistent short sleepers (average ≤5.5 h/night; 1.35 [1.04, 1.76]), but this evidence weakened on adjustment for BMI and change in weight (1.25 [0.96, 1.63]). CONCLUSIONS This study suggests that individuals whose sleep duration increases are at an increased risk of type 2 diabetes. Greater weight and weight gain in this group partly explain the association. </jats:sec

Job insecurity and risk of coronary heart disease : Mediation analyses of health behaviors, sleep problems, physiological and psychological factors

Job insecurity has been linked to increased risk of coronary heart disease (CHD), but underlying mechanisms remain uncertain. Our aim was to assess the extent to which this association is mediated through life style, physiological, or psychological factors. A total of 3917 men and women free from CHD provided data on job insecurity in the Whitehall II cohort study in 1997-1999. The association between job insecurity and CHD was decomposed into a direct and indirect effect mediated through unhealthy behaviors (smoking, high alcohol consumption, physical inactivity), sleep disturbances, 'allostatic load', or psychological distress. The counterfactual analyses on psychological distress indicated a marginally significant association between job insecurity and incident CHD (hazard ratio (HR) 1.32; 95 % confidence interval (CI) 1.00-1.75). This association was decomposed into a direct (HR 1.22, 95 %CI 0.92-1.63) and indirect association (1.08, 95 %CI 1.01-1.15), suggesting that about 30 % of the total relationship was mediated by psychological distress. No mediation was indicated via health behaviors, sleep disturbances, or allostatic load, although job insecurity was related to disturbed sleep and C-reactive protein, which, in turn were associated with CHD. In conclusion, our results suggest that psychological distress may play a role in the relation between job insecurity and CHD.Peer reviewe

Socioeconomic and Psychosocial Adversity in Midlife and Depressive Symptoms Post Retirement : A 21-year Follow-up of the Whitehall II Study

Peer reviewe