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OBJECTIVES: To assess survival in people who are at apparent high risk who do not develop coronary heart disease ("unwarranted survivals") and mortality in people at low risk who die from the disease ("anomalous deaths") and the extent to which these outcomes are explained by other, less visible, risk factors. DESIGN: Prospective general population survey. SETTING: Renfrew and Paisley, Scotland. PARTICIPANTS: 6068 men aged 45-64 years at screening in 1972-6, allocated to "visible" risk groups on the basis of body mass index and smoking. MAIN OUTCOME MEASURES: Survival and death from coronary heart disease by age 70 years. RESULTS: Visible risk was a good predictor of mortality: 13% (45) of men at low risk and 45% (86) of men at high risk had died by age 70 years. Of these deaths, 12 (4%) and 44 (23%), respectively, were from coronary heart disease. In the group at low visible risk other less visible risk factors accounted for increased risk in 83% (10/12) of men who died from coronary heart disease and 29% (84/292) of men who survived. In the high risk group 81/107 who survived (76%) and 19/44 (43%) who died from coronary heart disease had lower risk after other factors were considered. Different risk factors modified risk (beyond smoking and body mass index) in the two groups. Among men at low visible risk, poor respiratory function, diabetes, previous coronary heart disease, and socioeconomic deprivation modified risk. Among men at high visible risk, height and cholesterol concentration modified risk. CONCLUSIONS: Differences in survival between these extreme risk groups are dramatic. Health promotion messages would be more credible if they discussed anomalies and the limits of prediction of coronary disease at an individual level.

Current public health policy emphasizes the importance of primary and secondary prevention of coronary heart disease (CHD). However, evidence on the effectiveness of health advice to modify behavioural risk factors to date is discouraging. This lends urgency to understanding more about the public’s perceptions of the causes and consequences of heart disease, and particularly any barriers to adopting less coronary prone behaviours.

ObjectivesTo describe how adult sons and daughters report and perceive parental deaths from heart diseaseDesignTwo generation family study.SettingWest of Scotland.Subjects1040 sons and 1298 daughters aged 30-59 from 1477 families, whose fathers and mothers were aged 45-64 in 1972-76 and have been followed up for mortality over 20 years.OutcomePerception of a "family weakness" attributable to heart disease.Results26% of sons and daughters had a parent who had died of coronary heart disease (CHD). The proportion was higher in older offspring (+18% per 10 year age difference) and in manual compared with non-manual groups (+37%). Eighty nine per cent of parental deaths from CHD were correctly reported by offspring. Only 23% of sons and 34% of daughters with at least one parent who had died of CHD considered that they had a family weakness attributable to heart disease. Perceptions of a family weakness were higher when one or both parents had died of CHD, when parental deaths occurred at a younger age, in daughters compared with sons and in offspring in non-manual compared with manual occupations.ConclusionsOnly a minority of sons and daughters with experience of a parent having died from CHD perceive this in terms of a family weakness attributable to heart disease. Although men in manual occupations are most likely to develop CHD, they are least likely to interpret a parental death from CHD in terms of a family weakness. Health professionals giving advice to patients on their familial risks need to be aware of the difference between clinical definitions and lay perceptions of a family history of heart disease.

Qualitative research methods are now recognized as valuable tools for primary care. With the increasing emphasis on evidence-based medicine and critical appraisal of published work, it is important that qualitative researchers are transparent about their methods and discuss the impact of the research process on their data.

Study objectiveTo examine gender differences in minor morbidity among men and women working in similar circumstances, and to test whether the relation between reported working conditions and health is similar for men and women.DesignMultivariate analysis of data collected from a postal questionnaire distributed to full time employees in white collar jobs within a single organisation.SettingA British university.Participants1641 employees (1009 men and 632 women) working full time in white collar occupations in the university.Main resultsOverall, female university employees reported more "physical" symptoms (2.0 v 1.7, p<0.001) and more "malaise" symptoms (1.4 v 1.1, p<0.001) than male employees, but mean scores on a measure of minor psychiatric morbidity did not differ by gender. Poor perceived working conditions (and particularly lack of job stimulation, job drain and poor physical conditions) were consistently related to all three measures of minor morbidity, and these variables accounted for most of the variance in these health measures in this sample. When the analysis controlled for occupational grade, perceived working conditions and orientation to gender roles, there was no difference between men and women for any of the health measures. The relations for the predictor variables were generally the same for men and women (and there were no interactions with gender for any of the work related variables).ConclusionsAlthough small gender differences in recent experience of malaise and physical symptoms remain when examining men and women in as similar working circumstances as possible, these differences are cumulatively eroded by taking account of occupational grade, reported working conditions and orientation to gender. These results lend support to a differential exposure, rather than a differential vulnerability, model of gender differences in health.