PUBH6005: Epidemiology Assignment on Whitehall Study and Risk

This assignment analyzes the Whitehall Study, a significant longitudinal study investigating the relationship between employment grade, socioeconomic factors, and the incidence of coronary heart disease (CHD). The study examined the risk of CHD in British civil servants, establishing a clear inverse relationship between employment grade and CHD mortality. The assignment delves into the study's methodology, including sampling frames, questionnaires, and data collection methods across multiple phases. It explores the assessment of disease risk, specifically the use of job strain questionnaires to measure work-related stress and its association with CHD. The assignment also discusses the feasibility of conducting similar studies in other populations, such as Australia, and considers the generalizability of the Whitehall Study's findings. The provided solution includes an overview of the Whitehall I and II studies, detailing the sampling frame, data collection methods, and key findings related to the social determinants of health and disease risk assessment. The assignment provides insights into the impact of socioeconomic status and work stress on health outcomes and explores the applicability of these findings to different 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)
.

EPIDEMIOLOGY 3
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

EPIDEMIOLOGY 4
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
Chang, E., & Daly, J. (2012). Transitions in Nursing - E-Book: Preparing for Professional
Practice (3 ed.). Elsevier Health Sciences.
Killoran, A., & Kelly, M. P. (2010). Evidence-based Public Health: Effectiveness and Efficiency
(illustrated ed.). Patrick.
Kirch, W. (2012). Public Health in Europe: — 10 Years European Public Health Association —
(illustrated ed.). Springer Science & Business Media.
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
Naidoo, J., & Wills, J. (2010). Developing Practice for Public Health and Health Promotion E-
Book. Elsevier Health Sciences.
Nickitas, D. M., Middaugh, D. J., & Aries, N. (2010). Policy and Politics for Nurses and Other
Health Professionals. Jones & Bartlett Publishers.
Orth-Gomer, K., & Schneiderman, N. (2013). Behavioral Medicine Approaches to
Cardiovascular Disease Prevention. Psychology Press.
Webb, P., & Bain, C. (2010). Essential Epidemiology: An Introduction for Students and Health
Professionals (2, revised ed.). Cambridge University Press.
WHO. (2007). Prevention of Cardiovascular Disease: Guidelines for Assessment and
Management of Cardiovascular Risk (illustrated ed.). World Health Organization.

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