Social circumstances and healthSocial circumstances and health

2020thth century trends in life expectancy in Scotland century trends in life expectancy in Scotland and 16 other Western European countriesand 16 other Western European countries

Males

30

40

50

60

70

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000Year of birth

Life

exp

ecta

ncy

in y

ears

Scotland

Health InequalitiesHealth Inequalities

Are they due to:Are they due to:

– Poverty?Poverty?

– Diet ?Diet ?

– Tobacco?Tobacco?

Deprivation in 1981Deprivation in 1981

Deprivation in 1991Deprivation in 1991

Deprivation in 2001Deprivation in 2001

Excess Standardised Mortality not Excess Standardised Mortality not explained by deprivationexplained by deprivation(Scotland v. E&W)(Scotland v. E&W)

0

2

4

6

8

10

12

14

16

1981 1991 2001

Ex

ce

ss

Mo

rta

lity

(%

)

Age & Sex

Age, Sex & Deprivation

Coronary heart disease mortalityCoronary heart disease mortalityMen aged 15-74 yearsMen aged 15-74 years

100

200

300

400

500

600

1950 1960 1970 1980 1990

DenmarkFinlandNorwaySwedenScotland

Age

-sta

ndar

dise

d m

orta

lity

per

100

,000

World Health Organization (1997 and 2003)

www.heartstats.org

Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe

0

5

10

15

20

25

30

35

40

45

50

Ukraine

Lith

uania

Ger

man

y

Eston

ia

Slove

nia

Czech

Repu

blic

Latvi

a

Finlan

d

Hungar

y

Russia

n Fede

ratio

n

Austri

a

Franc

e

Polan

d

Switzer

land

Spain

Belgiu

m -

Flemish

spe

aking

Croat

ia

Nether

land

s

Belgiu

m -

Frenc

h sp

eakin

gIta

ly

United

Kin

gdom

- Eng

land

Irelan

d

Norway

Portu

gal

Denm

arkIs

rael

Malt

a

United

Kin

gdom

- Sco

tland

United

Kin

gdom

- W

ales

Mac

edonia,

FYR

Gre

ece

Sweden

% r

egu

lar

smo

kers

Boys

Girls

Smoking prevalence - EuropeSmoking prevalence - Europe

Males

Smoking prevalence - EuropeSmoking prevalence - Europe

Females

Comparison of lung cancer mortality in West of Scotland

and 3 major cohorts

0

100

200

300

400

500

0 10 20 30 40

Average number of cigarettes smoked daily

West of Scotland

UK doctorsAmerican Cancer Society volunteers

US veterans

Average

annual

death rate

/100,000

Lung cancer mortality by social class

0

20

40

60

80

100

never 1-14 15-24 25+

daily cigarette consumption

Rate per 10,000

manual

non-manual

Risk of death Risk of death - by level of hopelessness- by level of hopelessness

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

All cause CVD Non CVD Cancer

Low

Moderate

HighRHRRHR

Everson et al 1996Everson et al 1996

Carotid artery thickeningCarotid artery thickening

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

0

2

4

6

8

10

12

14

16

18

2008

-8.3

0

10-1

0.30

12-1

2.30

14-1

4.30

16-1

6.30

18-1

8.30

20-2

0.30

22-2

2.30

nmol

/l Higher GradeLower Grade

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

EFFECT OF JOB INSECURITY AND UNEMPLOYMENT ON HEALTH

0

50

100

150

200

250

300

Longstanding illness Poor Mental Health

Exc

ess

ill-h

ealt

h

Secure employment Insecure employment Unemployment

Source: Ferrie et al. BMJ,2001,322: 647-651

Depcat % smokers Never-smokers Smokers

1 36.8 0.71 1.42

2 35.9 1.00 2.34

3 39.1 1.11 2.25

4 44.1 1.21 2.44

5 46.6 1.13 2.53

6 49.3 1.25 3.07

7 55.5 1.48 3.29

Environmental determinants of Environmental determinants of inflammatory status inflammatory status

CRP (median) mg/dl

affluent

deprived

PP<0.001<0.001

PP<0.001<0.001

PP=0.03=0.03

Quartile of hs-CRP (Range, mg/dL)Quartile of hs-CRP (Range, mg/dL)

P P Trend <0.001Trend <0.001

0.0550.055 0.056–0.1140.056–0.114 0.115–0.2100.115–0.210 0.2110.211

Rel

ativ

e R

isk

of

MI

Rel

ativ

e R

isk

of

MI

Ridker. N Engl J Med. 1997;336:973–979.

0

1

2

3

1 2 3 4

hs-CRP and Risk of Future MI hs-CRP and Risk of Future MI in Apparently Healthy Men in Apparently Healthy Men

Inflammation in plaquesInflammation in plaques

Inflammatory cellsInflammatory cells

MMPs, IL-6, MMPs, IL-6, IL-15, IL-18, CRPIL-15, IL-18, CRP

LumenLumen

CoreCore

CapCap

Thin Thin Fibrous CapFibrous Cap

InflammatoryInflammatoryCellsCells

SMCSMC apoptosisapoptosis

DegradedDegradedmatrixmatrix

UnstableUnstable

cytokinescytokines MMPMMP

0

1

2

3

4

5

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Q1 : <0.66 mg/l

Q5: > 4.18 mg/l

Years in study

% diabetic

CRP and cumulative risk of type 2 diabetes

Freeman et al. Diabetes 2002,51;1596

Adipocyte programmingAdipocyte programming insulin resistance, inflammation and ALPinsulin resistance, inflammation and ALP

Adipose stores

NEFAs

liver

CRPSAA

IL-6/IL-6sR

TNF-TNF-sR-I

triglyceride

Low HDLsmall LDL

AtherogenicLipoproteinPhenotype

Pro-inflammatorystate

skeletal muscleInsulin resistance

Opportunity to escape Opportunity to escape poverty, decent housing, poverty, decent housing,

social networks, self esteem social networks, self esteem and sense of controland sense of control

Consistent parenting, safe, Consistent parenting, safe, nurturing early years, nurturing early years, supportive educationsupportive education

Health related Health related behavioursbehaviours