Health inequalities in British men: the impact of socio-economic circumstances at different stages of the life course.

Health inequalities in the UK remain marked; their reduction is an important public health priority. Health inequalities in the older population have been little studied and the pathways by which socio-economic status affects health remains incompletely understood. The purpose of this research is to investigate whether social gradients in health decline or widen with age and to examine the importance of socio-economic factors operating at different stages of the life course and at individual and area level. It will also seek to define the pathways by which socio-economic status affects health. The research will use a large and established British cohort study with a wide range of information on socio-economic and lifestyle factors and biological measures obtained at several time points. Understanding the relative importance of social factors operating at different stages of life, the relative importance of individual and area factors and the importance of health behaviours and biological risk markers in the development of social variations in health, will help to define public health strategies to reduce socio-economic inequalities in health in the future.

Health inequalities in the UK remain marked; their reduction is an important public health priority. I will use data from a long-term prospective study of British men to address important epidemiological issues about social inequalities in health in later life. I will examine:- (i) the extent of social inequalities in health in later life (ii) the influence of social determinants operating at different stages of the life course on these inequalities (iii) the importance of social factors operating at neighbourhood as well as individual level (iv) pathways through which social inequalities influence health risks. The British Regional Heart Study provides a unique opportunity to address these issues. It is a prospective study of 7735 men recruited at 40-59 years of age (1978-80) from a socially representative General Practice in each of 24 British towns who have provided regular and detailed information on socio-economic circumstances, behavioural factors and medical history, have been re-examined in detail after a 20 year interval at 60-79 years (1998-2000). Participants have been continuously followed up for all cause mortality, cardiovascular morbidity and cancer incidence for 25 years and for physical disability and handicap over the past 12 years. With these data I will be able to examine the extent to which social inequalities observed in middle age persist in later life for a wide range of mortality, morbidity and disability outcomes. I will define the extent to which social inequalities in later life are independently affected by retirement circumstances, social circumstances in middle age and social circumstances in childhood, or whether these interact (lifecourse approach). The extent to which neighbourhood and individual social circumstances influence health risk will be examined. Finally, I will study the pathways by which social circumstances influence risk, examining the contribution of health behaviours (diet, cigarette smoking, etc), established risk markers (adiposity, blood lipids and blood pressure), novel risk markers (including inflammatory and haemostatic factors) and the contribution of inequalities in health service provision for the prevention and management of chronic diseases. This research will enhance our understanding of the impact of socioeconomic status on health and of the factors that underlie these differentials to help develop public health strategies for reducing socio-economic inequalities in health. Demonstration of area-based effects would be important in emphasising the need to focus health promotion and policies aimed at reducing socio-economic inequality in health on the broader characteristics of the area in which people live.