Sampling Frame and Disease Risk Assessment in the Whitehall Study

This article discusses the sampling frame and disease risk assessment in the Whitehall study, including the feasibility of conducting similar studies in Australia and generalizing the results to other populations.

Running head: EPIDEMIOLOGY 1
Epidemiology
Name
Institutional affiliation

EPIDEMIOLOGY 2
Sampling Frame of the Whitehall Study
Whitehall I study sought to unmask the interconnection between coronary heart disease
mortality, employment grade and factors exposing one at risk of coronary disease (Killoran &
Kelly, 2010). The number of people enclosed by the longitudinal study were 17530 civil servants
based in London. Initially, screening examination was attended by 18403 men. Each individual
was presented with a with a standard questionnaire. The questionnaire mainly focused on
employment grade and based on received feedback, men were categorized into grades. They
were; executive, professional, administrative, clerical and others. However, 873 men from
British council and the diplomatic service were excluded from the study. This was because their
employment status’ were incomparable. The remaining sample population therefore comprised
of 17530 men from other employment departments (Naidoo & Wills, 2010). Records of over
99% of the participants were identified and tagged in the national health central registry. Any
participant who has therefore died henceforth have been accounted for as birth certificates are
availe.
In Whitehall study II, phase one conducted between 1985-1988 saw the recruitment of
10308 people to be assessed who emanated from twenty departments of civil service based in
London (Kirch, 2012). Phase 2 (1989-1990), phase 3 (1991-1993), phase 4 (1995), phase 5
(1997-1999), phase 6 (2001) and phase 7 (2002-2004) entailed data collection. In phases 2,4 & 6,
postal questionnaires were used. Phases 3,5 & 7 however entailed full clinical examination
(Marmot & Brunner, 2005)
.

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Disease Risk Assessment
In the study to bring into the limelight the mechanisms associated with work stress and
coronary heart disease, various criteria were used to assess the risk of the disease. Job strain
questionnaires were used to collect data relating to self-reported work stress. Addition of the
number of times that iso-strains were reported by participants at phases 1 and 2 enabled creation
of a cumulative measure of work stress. Data analysis involved use of cumulative measures of
work related stress to display the hazardous ratios of coronary heart disease occurrence. It was
therefore established that there was a direct connection between higher risks of coronary heart
disease and greater reports of work stress.
The second study involved establishing a relationship between the employment grades of
British civil servants and the prevalence of coronary heart disease amongst them. Data was
collected by issuing of questionnaires where the participants (men) were required to indicate
their employment grades amongst other details. It is from collected data that grades were
classified into professional, administrative, clerical, executive and the lowest work profile grade
being termed as ‘others.’ Data analysis sought to explain the coronary heart disease mortality
percentage amongst workers in various employment grades but in the same age limits.
The third study was based on 29 years of following up the Whitehall study. It sought to
explain whether social-economic drawbacks persisted onto old age. Given prior registration
during Whitehall 1 with the National Health Service Central Register, the body isolated the
various health authorities through which individual members of the cohort were registered to
various family doctors. Permission was granted by the chief executives of the individual health
authorities to the register to avail all the addresses of the survivors. Sent to the survivors

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identified henceforth were invitation letters, questionnaires, two reminders and consent forms.
Alongside the second reminder, a shortened version of the questionnaire entailing the crucial
information was attached. Statistical analysis was conducted using heterogeneity Chi-square tests
to establish univariate relationships. Odd ratios were estimated using logistics regression.
Generalization of the Results to Other Populations
Basing on the three studies, the overall results are applicable to other populations. This is
because the baseline coronary heart disease prevalence is directly attributable to the amount of
income being generated by the individuals in the population of choice (WHO, 2007). Pay grades
determine the amount of income that an individual earns and hence aligns the individual into
respective socioeconomic measures. Work stress is also prevalent to other populations and thus
results from these studies could be generalized to several populations.
Feasibility of Conducting Similar Studies
The feasibility of conducting similar studies in Australia is high. The 45 and up study
cohort could even prove to be more effective as it covers very large population of more than
26700 individuals at any single recruitment (Webb & Bain, 2010). Data collected would be
therefore well distributed and emanating from a larger sample. The Australian Women’s
longitudinal study cohort on the other hand could have a relatively low feasibility as all its
participants are women and thus data collected would not be a reflection of the whole society but
rather of one gender (Chang & Daly, 2012).

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References
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Killoran, A., & Kelly, M. P. (2010). Evidence-based Public Health: Effectiveness and Efficiency
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Kirch, W. (2012). Public Health in Europe: — 10 Years European Public Health Association —
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Marmot, M., & Brunner, E. (2005). Cohort Profile: The Whitehall II study. International
Journal of Epidemiology, 34(2). Retrieved 7 1, 2018, from
https://academic.oup.com/ije/article/34/2/251/746997
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