The relationship between employment grade and plasma fibrinogen level among Japanese male employees

  • Masao Ishizaki
    Corresponding author. Tel.: +44-171-5045629; fax: +44-171-8130242
    Department of Epidemiology and Public Health, International Centre for Health and Society, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK

    Health Care Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
    Search for articles by this author
  • Pekka Martikainen
    Department of Epidemiology and Public Health, International Centre for Health and Society, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK

    Department of Sociology, Population Research Unit, P.O. Box 18, FIN-00014, University of Helsinki, Helsinki, Finland
    Search for articles by this author
  • Hideaki Nakagawa
    Department of Public Health, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
    Search for articles by this author
  • Michael Marmot
    Department of Epidemiology and Public Health, International Centre for Health and Society, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK
    Search for articles by this author
  • on behalf of the YKKJ Research Group


      Plasma fibrinogen is an important risk factor for cardiovascular disease, and is associated with socioeconomic status in Europe and the United States. We evaluated whether the relationship between socioeconomic status and plasma fibrinogen level exists in Japanese male employees, and whether this relationship is independent of other correlates of plasma fibrinogen. This cross-sectional study was conducted on full-time male employees aged 20–58 in a metal-products factory between April 1996 and March 1997. Altogether 4375 employees (92.9%) participated. Low employment grade and low educational background were associated with increased age-adjusted plasma fibrinogen level. Adjusting for body mass index, waist to hip ratio, height, smoking habit, alcohol consumption, physical activity at leisure and systolic blood pressure did not attenuate these associations much. Adjusting for white blood cell count and hemoglobin A1c reduced the associations of both employment grade and educational background with plasma fibrinogen level, nevertheless these relationships remained significant.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Valkonen T.
        Adult mortality and level of education: a comparison of six countries.
        in: Fox J. Health Inequalities in European Countries. Gower Publishing, Aldershot1989: 142-146
        • 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; 337: 1387-1393
        • Davey-Smith G.
        • Neaton J.D.
        • Wentworth D.
        • Stamler R.
        • Stamler J.
        Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT.
        Lancet. 1998; 351: 934-939
        • Acheson D.
        Independent inquiry into inequalities in health. The Stationery Office, London1998
        • Kagamimori S.
        • Matsubara I.
        • Sokejima S.
        • Sekine M.
        • Matsukura T.
        • Nakagawa H.
        • Naruse Y.
        The comparative study on occupational mortality, 1980 between Japan and Great Britain.
        Ind. Health. 1998; 36: 252-257
      1. Statistics and Information Department, Minister’s Secretariat, Ministry of Health and Welfare. Special report of vital statistics in 1990: occupational and industrial aspects (in Japanese). Tokyo, Kousei Toukei Kyoukai, 1994.

        • Colhoun H.
        • Prescott-Clarke P.
        Health survey for England 1994. HMSO, London1996
        • Colhoun H.M.
        • Hemingway H.
        • Poulter N.R.
        Socio-economic status and blood pressure: an overview analysis.
        J. Hum. Hypertens. 1998; 12: 91-110
        • Rosengren A.
        • Wilhelmsen L.
        • Welin L.
        • Tsipogianni A.
        • Teger-Nilsson A.C.
        • Wedel H.
        Social influences and cardiovascular risk factors as determinants of plasma fibrinogen concentration in a general population sample of middle aged men.
        Br. Med. J. 1990; 300: 634-638
        • Brunner E.
        • Davey-Smith G.
        • Marmot M.
        • Canner R.
        • Beksinska M.
        • O’Brien J.
        Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen.
        Lancet. 1996; 347: 1008-1013
        • Lee A.J.
        • Lowe G.D.
        • Woodward M.
        • Tunstall-Pedoe H.
        Fibrinogen in relation to personal history of prevalent hypertension, diabetes, stroke, intermittent claudication, coronary heart disease, and family history: the Scottish Heart Health Study.
        Br. Heart J. 1993; 69: 338-342
        • Meade T.W.
        • Ruddock V.
        • Stirling Y.
        • Chakrabarti R.
        • Miller G.J.
        Fibrinolytic activity, clotting factors, and long-term incidence of ischaemic heart disease in the Northwick Park Heart Study.
        Lancet. 1993; 342: 1076-1079
        • Woodward M.
        • Lowe G.D.
        • Rumley A.
        • Tunstall-Pedoe H.
        Fibrinogen as a risk factor for coronary heart disease and mortality in middle-aged men and women. The Scottish Heart Health Study.
        Eur. Heart J. 1998; 19: 55-62
        • Brunner E.J.
        • Marmot M.G.
        • White I.R.
        • O’Brien J.R.
        • Etherington M.D.
        • Slavin B.M.
        • Kearney E.M.
        • Davey Smith D.
        Gender and employment grade differences in blood cholesterol, apolipoproteins and haemostatic factors in the Whitehall II study.
        Atherosclerosis. 1993; 102: 195-207
        • Woodward M.
        • Lowe G.D.
        • Rumley A.
        • Tunstall-Pedoe H.
        • Philippou H.
        • Lane D.A.
        • Morrison C.E.
        Epidemiology of coagulation factors, inhibitors and activation markers: the Third Glasgow MONICA Survey. II. Relationships to cardiovascular risk factors and prevalent cardiovascular disease.
        Br. J. Haematol. 1997; 97: 785-797
        • Baker I.A.
        • Sweetnam P.M.
        • Yarnell J.W.
        • Bainton D.
        • Elwood P.C.
        Haemostatic and other risk factors for ischaemic heart disease and social class: evidence from the Caerphilly and Speedwell studies.
        Int. J. Epidemiol. 1988; 17: 759-765
        • Lee A.J.
        • Smith W.C.
        • Lowe G.D.
        • Tunstall-Pedoe H.
        Plasma fibrinogen and coronary risk factors: the Scottish Heart Health Study.
        J. Clin. Epidemiol. 1990; 43: 913-919
        • Folsom A.R.
        Epidemiology of fibrinogen.
        Eur. Heart J. (Suppl A). 1995; 16: 21-23
        • Lip G.Y.
        Fibrinogen and cardiovascular disorders.
        Q. J. Med. 1995; 88: 155-165
        • Marmot M.G.
        • Bosma H.
        • Hemingway H.
        • Brunner E.
        • Stansfeld S.
        Contribution of job control and other risk factors to social variations in coronary heart disease incidence.
        Lancet. 1997; 350: 235-239
        • Prescott-Clarke P.
        • Primatesta P.
        Health survey for England ‘96. The Stationery Office, London1998
        • Lantz P.M.
        • House J.S.
        • Lepkowski J.M.
        • Williams D.R.
        • Mero R.P.
        • Chen J.
        Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults.
        J. Am. Med. Assoc. 1998; 279: 1703-1708
        • Folsom A.R.
        • Qamhieh H.T.
        • Flack J.M.
        • Hilner J.E.
        • Liu K.
        • Howard B.V.
        • Tracy R.P.
        Plasma fibrinogen: levels and correlates in young adults. The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
        Am. J. Epidemiol. 1993; 138: 1023-1036
        • Myllykangas M.
        • Pekkanen J.
        • Rasi V.
        • Haukkala A.
        • Vahtera E.
        • Salomaa V.
        Haemostatic and other cardiovascular risk factors, and socioeconomic status among middle-aged Finnish men and women.
        Int. J. Epidemiol. 1995; 24: 1110-1116
        • Wilson T.W.
        • Kaplan G.A.
        • Kauhanen J.
        • Cohen R.D.
        • Wu M.
        • Salonen R.
        • Salonen J.T.
        Association between plasma fibrinogen concentration and five socioeconomic indices in the Kuopio Ischemic Heart Disease Risk Factor Study.
        Am. J. Epidemiol. 1993; 137: 292-300
        • Luoto R.
        • Pekkanen J.
        • Uutela A.
        • Tuomilehto J.
        Cardiovascular risks and socioeconomic status: differences between men and women in Finland.
        J. Epidemiol. Commu. Health. 1994; 48: 348-354
        • Moller L.
        • Kristensen T.S.
        Plasma fibrinogen and ischemic heart disease risk factors.
        Arterioscler. Thromb. 1991; 11: 344-350
        • Markowe H.L.
        • Marmot M.G.
        • Shipley M.J.
        • Bulpitt C.J.
        • Meade T.W.
        • Stirling Y.
        • Vickers M.V.
        • Semmence A.
        Fibrinogen: a possible link between social class and coronary heart disease.
        Br. Med. J. 1985; 291: 1312-1314
      2. Health Service Bureau, Ministry of Health and Welfare. KOKUMIN-EIYO-NO-GENJO (in Japanese). Tokyo, Daiichi Shuppan, 1998.

        • Brunner E.J.
        • Marmot M.G.
        • Nanchahal K.
        • Shipley M.J.
        • Stansfeld S.A.
        • Juneja M.
        • Alberti K.G.
        Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study.
        Diabetologia. 1997; 40: 1341-1349
        • Folsom A.R.
        • Wu K.K.
        • Davis C.E.
        • Conlan M.G.
        • Sorlie P.D.
        • Szklo M.
        Population correlates of plasma fibrinogen and factor VII, putative cardiovascular risk factors.
        Atherosclerosis. 1991; 91: 191-205
      3. American Diabetes Association. Implications of the diabetes control and complications trial. Diabetes 1993;42:1555–1558.

        • Surwit R.S.
        • Schneider M.S.
        Role of stress in the etiology and treatment of diabetes mellitus.
        Psychosom. Med. 1993; 55: 380-393
        • Netterstrom B.
        • Danborg L.
        • Olesen H.
        Glycated hemoglobin as a measure of physiological stress.
        Behav. Med. 1988; 14: 13-16
        • Kawakami N.
        • Araki S.
        • Hayashi T.
        • Masumoto T.
        Relationship between perceived job-stress and glycosylated hemoglobin in white-collar workers.
        Ind. Health. 1989; 27: 149-154
        • Netterstrom B.
        • Kristensen T.S.
        • Damsgaard M.T.
        • Olsen O.
        • Sjol A.
        Job strain and cardiovascular risk factors: a cross sectional study of employed Danish men and women.
        Br. J. Ind. Med. 1991; 48: 684-689
        • Siegrist J.
        • Peter R.
        • Cremer P.
        • Seidel D.
        Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle-aged men.
        J. Intern. Med. 1997; 242: 149-156