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The Whitehall II Study

Mika Kivimäki, PhD; Jane E. Ferrie, PhD; Eric Brunner, PhD; Jenny Head, MSc; Martin J. Shipley, MSc; Jussi Vahtera, MD, PhD; Michael G. Marmot, FRCP

Arch Intern Med. 2005;165:2245-2251.

Background  Justice is a fundamental value in human societies, but its effect on health is poorly described. We examined justice at work as a predictor of coronary heart disease (CHD).

Methods  Prospective occupational cohort study of 6442 male British civil servants aged 35 to 55 years without prevalent CHD at baseline in phase 1 (1985-1988). Baseline screening included measurements of conventional risk factors. Perceived justice at work and other work-related psychosocial factors were determined by means of questionnaire at phases 1 and 2 (1989-1990). Follow-up for CHD death, first nonfatal myocardial infarction, or definite angina occurring from phase 2 through 1999 was based on medical records (mean follow-up, 8.7 years).

Results  Cox proportional hazard models adjusted for age and employment grade showed that employees who experienced a high level of justice at work had a lower risk of incident CHD than employees with a low or an intermediate level of justice (hazard ratio, 0.65; 95% confidence interval, 0.47-0.89). The hazard ratio did not materially change after additional adjustment for baseline cholesterol concentration, body mass index, hypertension, smoking, alcohol consumption, and physical activity. Although other psychosocial models such as job strain and effort-reward imbalance predicted CHD in these data, the level of justice remained an independent predictor of incident CHD after adjustment for these factors.

Conclusion  Justice at work may have benefits for heart health among employees.

Author Affiliations: Finnish Institute of Occupational Health and University of Helsinki, Helsinki, Finland (Drs Kivimäki and Vahtera); and Department of Epidemiology and Public Health, International Centre for Health and Society, University College London Medical School, London, England (Drs Ferrie, Brunner, and Marmot and Mss Head and Shipley).

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