Skip to main content
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Jun;52(6):353–358. doi: 10.1136/jech.52.6.353

Behavioural and biological correlates of physical functioning in middle aged office workers: the UK whitehall II study

M Stafford, H Hemingway, S A Stansfeld, E Brunner, M Marmot
PMCID: PMC1756727  PMID: 9764255

Abstract

STUDY OBJECTIVES: (1) To identify behavioural and biological correlates of poor physical functioning and (2) to determine whether such associations are independent of disease. DESIGN: Potential correlates were obtained from questionnaires and screening visits at baseline and five year follow up. Physical functioning was measured at follow up using the 10 item scale from the short-form 36 health survey. SETTING: London offices at baseline. PARTICIPANTS: 10,308 civil servants (6895 men and 3413 women), with a median age (range) of 49 years (39-63) at follow up. MAIN RESULTS: Multiple logistic regression showed that cigarette smoking, physical activity, body mass index (BMI), triglycerides, fibrinogen, and insulin were independently associated with poor physical functioning for men. For women, physical activity, eating habits, body mass index, fibrinogen, and insulin were independently associated with poor physical functioning. For example, among men, current smokers who had smoked more than 20 pack years were 1.89 (95% CI 1.35 to 2.67) times as likely to have poor physical functioning as never smokers. Men with BMI of 30 kg/m2 or more were 1.71 (95% CI 1.13 to 2.59) times as likely to have poor physical functioning as those with BMI < 20 kg/m2. The corresponding odds ratio for women was 2.66 (95% CI 1.80 to 3.93). With the exceptions of fibrinogen and insulin, associations remained on exclusion of subjects with physical disease. CONCLUSIONS: Risk factors established for physical diseases are associated with poor physical functioning in a population of working age. These associations may be independent of current disease.

 

Full Text

The Full Text of this article is available as a PDF (132.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berkman L. F., Seeman T. E., Albert M., Blazer D., Kahn R., Mohs R., Finch C., Schneider E., Cotman C., McClearn G. High, usual and impaired functioning in community-dwelling older men and women: findings from the MacArthur Foundation Research Network on Successful Aging. J Clin Epidemiol. 1993 Oct;46(10):1129–1140. doi: 10.1016/0895-4356(93)90112-e. [DOI] [PubMed] [Google Scholar]
  2. Bild D. E., Fitzpatrick A., Fried L. P., Wong N. D., Haan M. N., Lyles M., Bovill E., Polak J. F., Schulz R. Age-related trends in cardiovascular morbidity and physical functioning in the elderly: the Cardiovascular Health Study. J Am Geriatr Soc. 1993 Oct;41(10):1047–1056. doi: 10.1111/j.1532-5415.1993.tb06451.x. [DOI] [PubMed] [Google Scholar]
  3. Bowling A. The effects of illness on quality of life: findings from a survey of households in Great Britain. J Epidemiol Community Health. 1996 Apr;50(2):149–155. doi: 10.1136/jech.50.2.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Branch L. G. Health practices and incident disability among the elderly. Am J Public Health. 1985 Dec;75(12):1436–1439. doi: 10.2105/ajph.75.12.1436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brunner E. J., Marmot M. G., White I. R., O'Brien J. R., Etherington M. D., Slavin B. M., Kearney E. M., Smith G. D. Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study. Atherosclerosis. 1993 Sep;102(2):195–207. doi: 10.1016/0021-9150(93)90162-n. [DOI] [PubMed] [Google Scholar]
  6. Detsky A. S. Regional variation in medical care. N Engl J Med. 1995 Aug 31;333(9):589–590. doi: 10.1056/NEJM199508313330911. [DOI] [PubMed] [Google Scholar]
  7. Ettinger W. H., Davis M. A., Neuhaus J. M., Mallon K. P. Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: Effects of comorbid medical conditions. J Clin Epidemiol. 1994 Jul;47(7):809–815. doi: 10.1016/0895-4356(94)90178-3. [DOI] [PubMed] [Google Scholar]
  8. Ettinger W. H., Jr, Fried L. P., Harris T., Shemanski L., Schulz R., Robbins J. Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group. J Am Geriatr Soc. 1994 Oct;42(10):1035–1044. doi: 10.1111/j.1532-5415.1994.tb06206.x. [DOI] [PubMed] [Google Scholar]
  9. Garratt A. M., Ruta D. A., Abdalla M. I., Buckingham J. K., Russell I. T. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ. 1993 May 29;306(6890):1440–1444. doi: 10.1136/bmj.306.6890.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Harris T., Kovar M. G., Suzman R., Kleinman J. C., Feldman J. J. Longitudinal study of physical ability in the oldest-old. Am J Public Health. 1989 Jun;79(6):698–702. doi: 10.2105/ajph.79.6.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hemingway H., Nicholson A., Stafford M., Roberts R., Marmot M. The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II Study. Am J Public Health. 1997 Sep;87(9):1484–1490. doi: 10.2105/ajph.87.9.1484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Idler E. L., Angel R. J. Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health. 1990 Apr;80(4):446–452. doi: 10.2105/ajph.80.4.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaplan G. A., Camacho T. Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. Am J Epidemiol. 1983 Mar;117(3):292–304. doi: 10.1093/oxfordjournals.aje.a113541. [DOI] [PubMed] [Google Scholar]
  14. Lyons R. A., Lo S. V., Littlepage B. N. Comparative health status of patients with 11 common illnesses in Wales. J Epidemiol Community Health. 1994 Aug;48(4):388–390. doi: 10.1136/jech.48.4.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Mackenbach J. P., van den Bos J., Joung I. M., van de Mheen H., Stronks K. The determinants of excellent health: different from the determinants of ill-health? Int J Epidemiol. 1994 Dec;23(6):1273–1281. doi: 10.1093/ije/23.6.1273. [DOI] [PubMed] [Google Scholar]
  16. Markides K. S., Lee D. J. Predictors of well-being and functioning in older Mexican Americans and Anglos: an eight-year follow-up. J Gerontol. 1990 Mar;45(2):S69–S73. doi: 10.1093/geronj/45.2.s69. [DOI] [PubMed] [Google Scholar]
  17. Marmot M. G., Smith G. D., Stansfeld S., Patel C., North F., Head J., White I., Brunner E., Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. doi: 10.1016/0140-6736(91)93068-k. [DOI] [PubMed] [Google Scholar]
  18. Marmot M., Feeney A., Shipley M., North F., Syme S. L. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995 Apr;49(2):124–130. doi: 10.1136/jech.49.2.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McHorney C. A., Ware J. E., Jr, Lu J. F., Sherbourne C. D. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. doi: 10.1097/00005650-199401000-00004. [DOI] [PubMed] [Google Scholar]
  20. McHorney C. A., Ware J. E., Jr, Raczek A. E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247–263. doi: 10.1097/00005650-199303000-00006. [DOI] [PubMed] [Google Scholar]
  21. Morris J. N. Exercise in the prevention of coronary heart disease: today's best buy in public health. Med Sci Sports Exerc. 1994 Jul;26(7):807–814. [PubMed] [Google Scholar]
  22. Mossey J. M., Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982 Aug;72(8):800–808. doi: 10.2105/ajph.72.8.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nagi S. Z. An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc. 1976 Fall;54(4):439–467. [PubMed] [Google Scholar]
  24. Palmore E. B., Nowlin J. B., Wang H. S. Predictors of function among the old-old: a 10-year follow-up. J Gerontol. 1985 Mar;40(2):244–250. doi: 10.1093/geronj/40.2.244. [DOI] [PubMed] [Google Scholar]
  25. Pinsky J. L., Branch L. G., Jette A. M., Haynes S. G., Feinleib M., Cornoni-Huntley J. C., Bailey K. R. Framingham Disability Study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease. Am J Epidemiol. 1985 Oct;122(4):644–656. doi: 10.1093/oxfordjournals.aje.a114144. [DOI] [PubMed] [Google Scholar]
  26. Roviaro S., Holmes D. S., Holmsten R. D. Influence of a cardiac rehabilitation program on the cardiovascular, psychological, and social functioning of cardiac patients. J Behav Med. 1984 Mar;7(1):61–81. doi: 10.1007/BF00845347. [DOI] [PubMed] [Google Scholar]
  27. Rubinstein I., Zamel N., DuBarry L., Hoffstein V. Airflow limitation in morbidly obese, nonsmoking men. Ann Intern Med. 1990 Jun 1;112(11):828–832. doi: 10.7326/0003-4819-112-11-828. [DOI] [PubMed] [Google Scholar]
  28. Sandvik L., Erikssen G., Thaulow E. Long term effects of smoking on physical fitness and lung function: a longitudinal study of 1393 middle aged Norwegian men for seven years. BMJ. 1995 Sep 16;311(7007):715–718. doi: 10.1136/bmj.311.7007.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Satin M. S., Monetti C. H. Census tract predictors of physical, psychological, and social functioning for needs assessment. Health Serv Res. 1985 Aug;20(3):341–358. [PMC free article] [PubMed] [Google Scholar]
  30. Seeman T. E., Charpentier P. A., Berkman L. F., Tinetti M. E., Guralnik J. M., Albert M., Blazer D., Rowe J. W. Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging. J Gerontol. 1994 May;49(3):M97–108. doi: 10.1093/geronj/49.3.m97. [DOI] [PubMed] [Google Scholar]
  31. Spiegel J. S., Leake B., Spiegel T. M., Paulus H. E., Kane R. L., Ward N. B., Ware J. E., Jr What are we measuring? An examination of self-reported functional status measures. Arthritis Rheum. 1988 Jun;31(6):721–728. doi: 10.1002/art.1780310604. [DOI] [PubMed] [Google Scholar]
  32. Spitzer R. L., Kroenke K., Linzer M., Hahn S. R., Williams J. B., deGruy F. V., 3rd, Brody D., Davies M. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995 Nov 15;274(19):1511–1517. [PubMed] [Google Scholar]
  33. Stewart A. L., Hays R. D., Wells K. B., Rogers W. H., Spritzer K. L., Greenfield S. Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the Medical Outcomes Study. J Clin Epidemiol. 1994 Jul;47(7):719–730. doi: 10.1016/0895-4356(94)90169-4. [DOI] [PubMed] [Google Scholar]
  34. Strawbridge W. J., Camacho T. C., Cohen R. D., Kaplan G. A. Gender differences in factors associated with change in physical functioning in old age: a 6-year longitudinal study. Gerontologist. 1993 Oct;33(5):603–609. doi: 10.1093/geront/33.5.603. [DOI] [PubMed] [Google Scholar]
  35. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  36. Ware J. E., Jr The status of health assessment 1994. Annu Rev Public Health. 1995;16:327–354. doi: 10.1146/annurev.pu.16.050195.001551. [DOI] [PubMed] [Google Scholar]
  37. Yates B. C., Belknap D. C. Predictors of physical functioning after a cardiac event. Heart Lung. 1991 Jul;20(4):383–390. [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES