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RESEARCH AND PRACTICE |
At the time of the study, R. Fuhrer was with the Department of Epidemiology and Public Health, University College London, Great Britain, and Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France. M. J. Shipley is with the Department of Epidemiology and Public Health, University College London. J. F. Chastang, A. Schmaus, I. Niedhammer, and M. Goldberg are with INSERM, St. Maurice, France. S. A. Stansfeld and M. G. Marmot are with the International Centre for Health and Society, Department of Epidemiology and Public Health, University College London.
Correspondence: Requests for reprints should be sent to R. Fuhrer, PhD, Department of Epidemiology and Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal QC H3A 1A2 Canada (e-mail:
rebecca.fuhrer{at}mcgill.ca).
Objectives. We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient.
Methods. This longitudinal study of 2 occupational cohorts—5825 London civil servants and 6818 French office-based employees—used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health.
Results. Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health.
Conclusions. Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality.
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