UCL RESEARCH DEPARTMENT OF EPIDEMIOLOGY AND PUBLIC HEALTH

Evidence-based targets for intervention to reduce socioeconomic inequalities in health have typically been identified using the adjustment method in observational data: the greater attenuation in relative risk of disease between advantaged and disadvantaged groups after adjustment for candidate risk factors, the greater the potential to reduce inequalities via interventions that target those specific factors. Similarly, plausible mechanisms underlying the adverse health effects of poor psychosocial work environment have been explored by adjustments. It has now become clear that this method is far from optimal for prioritizing intervention targets. This is because it does not take into account the extent to which reduction in each risk factor is feasible.

Our team recently introduced a novel approach to this problem, Lancet 2008;372:1648-54. It examines the extent to which interventions involving established risk factors, if adopted by both disadvantaged and advantaged groups, could reduce health inequalities. The method models intervention effects that are known to be feasible. We will apply this approach for 7 well-characterised European cohorts, with the main analyses being based on the Whitehall II study. Besides CHD, diabetes and common mental disorders, we will identify best intervention targets to reduce inequalities in chronic low-grade inflammation state.

The specific objectives are:

(1) To examine the contribution of established interventions on risk factors, such as blood pressure, cholesterol, glucose, and smoking, if adopted by both disadvantaged and advantaged groups, to reduce socioeconomic inequalities in coronary heart disease, common mental disorders, diabetes and chronic inflammation.

(2) To examine the contribution of feasible changes in upstream factors, such as dietary patterns, physical activity and body mass index, to reduce relative and absolute socioeconomic inequalities in these health outcomes.

(3) To quantify the extent to which a healthy lifestyle (in terms of diet, physical activity and normal weight) and good control over the established risk factors reduces the adverse effects of poor psychosocial work environment on coronary heart disease, common mental disorders, diabetes and chronic inflammation.