Unfairness and the social gradient of metabolic syndrome in Whitehall II Study B Roberto De Vogli 4 , Eric Brunner, Michael G. Marmot International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, United Kingdom Received 22 September 2006; received in revised form 3 April 2007; accepted 10 April 2007 Abstract Objectives:Little work has investigated the relationship between unfairness and risk factors for heart disease. We examine the role of unfairness in predicting the metabolic syndrome and explainingthe social gradientof the metabolicsyndrome. Methods:The design isa prospective study with an average follow-up of5.8 years. Participants were 4128 males and 1715 females of 20 civil service departments in London (Whitehall II study). Sociodemographics, unfairness,employment grade, behavioral risk factors,and otherpsychosocial factorswere measured at baseline (Phase 3, 1991–1993). Waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, fasting glucose,and hypertensionwere usedto definemetabolic syndrome at follow-up (Phase 5, 1997–2000), according to the National Cholesterol Education Program/Adult Treatment Panel III guidelines. Results:Unfairness is positively associated with waist circumference, hypertension, triglycerides, and fasting glucose and negatively associated with serum HDL cholesterol High levels of unfairness are also associated with the metaboli syndrome[oddsratio (OR)=1.72, 95% CI=1.31–2.25], after adjustment for age and gender. After additional adjustment for employment grade, behavioral risk factors, and other psychoso- cial factors,the relationshipbetweenhigh unfairnessand metabolicsyndromeweakenedbut remainedsignificant (OR=1.37, 95% CI=1.00–1.93). When adjusting for unfairness, thesocialgradientofmetabolicsyndromewasreducedby approximately 10%. Conclusion: Unfairness may be a risk factor for the metabolic syndrome and its components. Future research is needed to study the biological mechanisms linking unfairness and the metabolic syndrome. D 2007 Elsevier Inc. All rights reserved. Keywords: Metabolic syndrome; Unfairness; Justice; Social class; Psychosocial factors Introduction Fairness, defined as the quality of treating people equally or in a way thatis rightor reasonable [1], is widely recognized as a key principle of human behavior, social relations, and the organization of society [2–5]. Acts of relational and societal unfairness can be conceptualized as violations of people’s dignity or self-respect [6,7] that ma produce negative stress-related reactions that increase the risk ofpoormental and physical health [8,9]. In a recent study, participants reporting higher levels of unfairness w morelikely to experiencean incidentcoronary event (excluding self-reported cases), compared to those with low or medium unfairness, after adjustment for age, gend employment grade,traditional coronary risk factors, and other psychosocial work characteristics [10]. Unfairness also an independent predictor of poor mental and physical health functioning [10]. Mediating mechanisms through which unfairnessaffectsheartdiseasehavenot been investigated yet, and we are not awareof studiesthat 0022-3999/07/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2007.04.006 B The Whitehall II study hasbeen supported by grants from the MedicalResearch Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US National Institutes of Health (NIH): National Institute on Aging (AG13196), US NIH; Agency forHealth Care Policy Research (HS06516); and the John D.and Catherine T. MacArthurFoundation Research Networks on Successful Midlife Development and Socioeco- nomic Status and Health. R.D. is supported by the National Institute on Aging.M.M. is supported by an MRC Research Professorship. 4 Corresponding author. International Institute for Society and Health, Department of Epidemiology and Public Health,UniversityCollege London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom. E-mail address: r.devogli@ucl.ac.uk (R. De Vogli). Journal of Psychosomatic Research 63 (2007) 413 – 419