Marmot M G, Rose G, Shipley M, Hamilton P J
J Epidemiol Community Health (1978). 1978 Dec;32(4):244-9. doi: 10.1136/jech.32.4.244.
The relationship between grade of employment, coronary risk factors, and coronary heart disease (CHD) mortality has been investigated in a longitudinal study of 17 530 civil servants working in London. After seven and a half years of follow-up there was a clear inverse relationship between grade of employment and CHD mortality. Men in the lowest grade (messengers) had 3.6 times the CHD mortality of men in the highest employment grade (administrators). Men in the lower employment grades were shorter, heavier for their height, had higher blood pressure, higher plasma glucose, smoked more, and reported less leisure-time physical activity than men in the higher grades. Yet when allowance was made for the influence on mortality of all of these factors plus plasma cholesterol, the inverse association between grade of employment and CHD mortality was still strong. It is concluded that the higher CHD mortality experienced by working class men, which is present also in national statistics, can be only partly explained by the established coronary risk factors.
在一项对1.753万名在伦敦工作的公务员进行的纵向研究中，调查了就业等级、冠心病风险因素与冠心病（CHD）死亡率之间的关系。经过七年半的随访，就业等级与冠心病死亡率之间存在明显的负相关关系。最低等级（信使）的男性冠心病死亡率是最高就业等级（管理人员）男性的3.6倍。较低就业等级的男性比高等级男性个子更矮、按身高计算体重更重、血压更高、血糖更高、吸烟更多，且报告的休闲时间身体活动更少。然而，当考虑到所有这些因素以及血浆胆固醇对死亡率的影响时，就业等级与冠心病死亡率之间的负相关关系仍然很强。得出的结论是，工人阶级男性较高的冠心病死亡率（这在全国统计数据中也存在），只能部分地由既定的冠心病风险因素来解释。
