Bin b presentation27sept07

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Born in Bradford

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  • All are higher than the England & Wales figure. Pendle has a higher infant mortality rate than Bradford (small numbers), Blackburn, Kirklees and Preston have marginally lower infant mortality rates, however the differences are not significant (Overlapping confidence intervals)
  • Areas defined using extent scores (measure of how many of the countries most deprived areas in district) Areas with high levels of deprivation are likely to have high infant mortality rates Based on the IMD2004 extent score, Rochdale and Mansfield are slightly less deprived than Bradford, Doncaster and Leicester slightly more deprived Some areas with similar levels of deprivation to Bradford have significantly lower infant mortality rates: Mansfield Doncaster Rochdale and Leicester also seem to have slightly lower rates than Bradford but are not statistically significant Overlapping confidence intervals
  • A babies birth weight is an important indicator of infant health. Bradford has a high rate of LBW compared to rest of country (9.7% v 7.5%) Between 1996 and 2003 12.5% of babies born in most deprived areas compared to 6.2% in least deprived areas. However deaths were spread across all birthweights pre term and full term babies are not a factor in postnatal deaths and infant deathsl. Bradford district babies of all weights are more likely to die in the postnatal and infant period than babies of a similar birth weight in England and Wales and this is not fully explained by LBW
  • Bin b presentation27sept07

    1. 1. Born In Bradford Neil Small Professor of Health Research School of Health Studies University of Bradford 25 Trinity Road, Bradford, BD5 OBB Tel: 01274 236456 Fax: 01274 236458 Email: N.A.Small@bradford.ac.uk www.bradford.ac.uk/acad/health/research/pcg
    2. 2. .. What a cohort study is andwhy we are conducting one.. Why Bradford is a goodplace to do such a study.. Study objectives.. What data we will collectand whenStudy Benefits / StudyChallenges
    3. 3. Cohort studies: background• You are not pre-selecting a group to study• You can visit the same people over time.• You can consider the whole context of a life - how far is it ethnicity, deprivation, genetics or behaviour that shape a persons health profileIf you do it in one place you can linkfindings with service provision
    4. 4. Existing cohort studies• There are a wide range internationally• UK studies include – 1946 cohort (one weeks births) – sample of 5362 followed up at intervals – now 21 times• West of Scotland – 3 cohorts recruited in 1987 when aged 15, 35 and 55 – to be followed for 20 years Millennium cohort – 19000 babies born in 2000• ALSPAC – Avon (Bristol) 14000 children born in 1991/2
    5. 5. Why Bradford?• Diverse population• Stable community• One maternity unit• Integrated health services• Connected IT• Enthusiasm• Development of research infrastructure
    6. 6. Bradford Population• Bradford has a population of around half a million• 22% of population are less than 15 compared to 18% in England and Wales• Has a significant Asian population, mainly living in inner city areas
    7. 7. 85 plus80 to 8475 to 7970 to 7465 to 6960 to 6455 to 5950 to 5445 to 4940 to 4435 to 3930 to 3425 to 2920 to 2415 to 1910 to 14 5 to 9 0 to 4 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% Male Female England & Wales
    8. 8. 10 9 8 7 6Rate per 1000 live births 5 4 3 2 1 0 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 Bradford England & Wales Infant Mortality Rate, Bradford and England and Wales
    9. 9. 14 12 Most deprived 10 2nd most deprivedRate per 1000 live births 8 3rd most deprived 6 2nd least deprived 4 Least deprived 2 0 1993-1997 1994-1998 1995-1999 1996-2000 1997-2001 1998-2002 1999-2003 Infant Mortality by Deprivation Quintile within Bradford 1993-97 to 1999-03
    10. 10. Comparative Infant Mortality Rates for Areas with Similar Populations to Bradford Infant Mortality Rate Blackburn with Preston CD England and 18 Bradford MCD Kirklees MCD Pendle CD Darwen UA Wales 16 14 12 10Rate 8 6 4 2 0 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002
    11. 11. Comparative Infant Mortality Rates for Areas with Similar Levels of Deprivation Infant Mortality Rate 12 Bradford MCD Doncaster MCD Rochdale MCD Leicester UA Mansfield CD England and Wales 10 8Rate 6 4 2 0 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002
    12. 12. Low birth weight (less than 2500g) rate by ward 1993 - 2003
    13. 13. MATERNAL UTEROPLACENTAL PLACENTAL FETAL DIET BLOOD FLOW TRANSFER GENOME Nutrient demand exceeds supply FETAL UNDERNUTRITION BRAIN SPARING DOWN REGULATION EARLY ALTERED BODY OF GROWTH MATURATION COMPOSITIONIMPAIRED DEVELOPMENT:  INSULIN/IGF-1 SECRETION  CORTISOL MUSCLE BLOOD VESSELS, LIVER, AND SENSITIVITYKIDNEYS, PANCREAS HYPERLIPIDAEMIA CENTRAL INSULIN HYPERTENSION OBESITY RESISTANCE Type 2 diabetes and CHD
    14. 14. Childhood disabilityVisual impairment58% Pakistani children vs 29% White British childrenSchwarz et al. Eye 2002;16:S30-34Deafness4.7 per 1000 Pakistani children vs 1.4 per 1000 othersParry G. BACDA report 1996Cerebral Palsy5.48 per 1000 in Pakistani children vs 3.18 per 1000 in othersSinha et al Dev Med Child Neurol 1997 39:259-262
    15. 15. District Number of cases (total 736)Bradford 50Birmingham 31East London & City 25East Riding 22Berkshire 19
    16. 16. Bundey and Aslam 1993 Eur J Hum Genet 206-219 Empirical risk of death or serious disease European (n = 2,241) Consanguineous Pakistani (n = 656)Rate 3.7% (2.92-4.48) 10.2 (7.9-12.5)
    17. 17. Platform and nested studies• We have started recruiting pregnant mothers in March and babies in May• We will recruit all newborn babies and their parents born in BRI or under the care of the BRI over 30 months (target numbers – 10000)A platform study: Most data for the study will be routinely collected data – health history, demographics, weight, blood samples etc. This will be supplemented with some specific questions eg more on maternal diet, more on home circumstances.“Nested” studies – specific research questions that use the cohort as the source of their study population.
    18. 18. Research aims– To explore the association between specific risk factors and exposures in pregnancy and infancy with infant mortality.– To describe the differences in foetal growth and birth weight between ethnic groups and to investigate the causes of low birth weight in babies of South Asian origin– To explore the effect of chemical exposure (air/water/ diet) during pregnancy on the intrauterine growth– To determine the incidence, causes and predictive factors for congenital abnormalities
    19. 19. Further research– To investigate the association between dietary exposure to chemicals with carcinogenic and immunotoxic properties with childhood cancer and immune disorders.– To study infant growth and investigate the effect of postnatal growth on childhood obesity and markers of cardiovascular disease in childhood.– To describe social and ethnic differences in health status and the effects of ethnic density on health status and pregnancy outcomes.
    20. 20. Data collected• Demographic/socio-economic• Family history• Lifestyle factors – smoking/drugs/alcohol/exercise• Diet – modified food frequency + targeted questions re exposures• Well being – GHQ 28• Social Capital (on sub set of 2000)• Clinical: antenatal and medical histories; drugs; BP; weight; U/S scans.• Blood: routine; GTT; insulin; DNA extraction
    21. 21. Progress so far• Community awareness• NHS support• IT systems• Questionnaire design• Biobank• Advocacy committee• Fundraising• Feasibility study• Pilot phase
    22. 22. Benefits.• Full use of routinely collected data• Growth of research activity/ capacity/ skills and opportunity in the city• Focus for collaboration within health and with local government and community organisations.
    23. 23. Main challenges• Funding• Data collection – information systems accessible and compatible• Differential recruitment and drop-out• Lack of enthusiasm from staff• Subject burden• Reconciling long-term gains and short term “wins”

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