Intended for healthcare professionals


Social inequalities in self reported health in early old age: follow-up of prospective cohort study

BMJ 2007; 334 doi: (Published 10 May 2007) Cite this as: BMJ 2007;334:990
  1. Tarani Chandola, senior lecturer,
  2. Jane Ferrie, senior research fellow,
  3. Amanda Sacker, principal research fellow,
  4. Michael Marmot, professor
  1. International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London SE11 4LD
  1. Correspondence to: T Chandola t.chandola{at}
  • Accepted 15 February 2007


Objective To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade.

Design Prospective cohort study of office based British civil servants (1985-2004).

Participants 10 308 men and women aged 35-55 at baseline, employed in 20 London civil service departments (the Whitehall II study); follow-up was an average of 18 years.

Main outcome measures Physical component and mental component scores on SR-36 measured on five occasions.

Results Physical health deteriorated more rapidly with age among men and women from the lower occupational grades. The average gap in physical component scores between a high and low grade civil servant at age 56 was 1.60 and this gap increased by 1 over 20 years. The average physical health of a 70 year old man or woman who was in a high grade position was similar to the physical health of a person from a low grade around eight years younger. In mid-life, this gap was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades.

Conclusions Social inequalities in self reported health increase in early old age. People from lower occupational grades age faster in terms of a quicker deterioration in physical health compared with people from higher grades. This widening gap suggests that health inequalities will become an increasingly important public health issue, especially as the population ages.


  • We thank all participating civil service departments and their welfare, personnel, and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; and all members of the Whitehall II study team. In addition, we thank Paul Clarke for his invaluable statistical advice.

  • Contributors: TC wrote the first draft, did the analysis, and is guarantor. JF, AS, and MM contributed to subsequent drafts of the paper by writing sections and suggesting new analytical strategies.

  • Funding: The Whitehall II study has been supported by grants from the Medical Research Council; Economic and Social Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310) and National Institute on Aging (AG13196); Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. MM is supported by an MRC research professorship.

  • Competing interests: None declared.

  • Ethical approval: University College London Medical School committee on the ethics of human research.

  • Accepted 15 February 2007
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