Neil Small's Born in Bradford presentation at the Supporting Families in Difficult Times Conference held on 18-19th September 2014

1. Deprivation, ethnicity and health
differences in the Born in Bradford
study
Neil Small,
Professor of Health Research,
School of Health Studies, University of Bradford
N.A.Small@bradford.ac.uk
http://www.brad.ac.uk/health/research/research-staff-profiles/neil-small.php

3. Bradford local health profile Public Health
Observatory England 2011
• Life expectancy – Men born in the district 76.4
(England average 78.3) : Women 80.4 (82.3)
• Comparing least and most deprived areas of
Bradford: Men – 11.9 years more: women 7.2
years more.

5. Infant mortality – worldwide deaths before age 1
per 1000 live births
• Democratic Republic of Congo 100
• Nigeria 78
• Kenya 49
• Pakistan 69
• India 44
• Bangladesh 33
• Sri Lanka 9
• USA 6
• UK 4
• Sweden 2
(World Bank, World Development Indicators 2014)

6. Infant mortality rates in most deprived quintile , Bradford District,
Region and England during 2007-09 to 2010- 2012
Source: Public Health Analysis Team City of Bradford Metropolitan
District Council
Year Bradford
Most
Deprived
Quintile
Bradford
rate
Yorkshire
&
Humber
England
2007-2009 10.6 8.1 5.3 4.6
2008-2010 10.2 8.0 5.4 4.6
2009-2011 9.0 7.5 5.2 4.4
2010-2012 7.8 7.0 4.8 4.3
% Change -26.7 -13.1 -9.4 -6.5

7. Cause of death by ethnicity, 2000-2009
Infant Mortality Analysis Update 2011, NHS Bradford and Airedale , Dance J. et al
Congenital Anomalies
Immaturity
0 2 4 6 8 10 12 14
White
Pakistani 1st gen
Pakistani 2nd gen
Other
Mortality rate per 1000 births
Other specific conditions
Other conditions
External conditions
Immaturity related conditions
Asphyxia, anoxia or trauma
Antepartum infections
Sudden infant deaths
Infections
Congenital anomalies

8. Existing birth cohort studies
Examples in UK:
National Survey of Health and Development – a representative sample of 5362 men and women who were born in
March 1946.
ALSPAC – Avon (Bristol) 14000 children born in 1991/2
Millennium cohort – 19000 babies born in 2000
LIFE study – funded by ESRC/MRC– based at UCL the study will collect social, heath and biological information on
80,000 babies born across the UK between 2014-18 and their families
• why some babies develop asthma, eczema and food allergies while others do not
• how children get ready for learning at school during their preschool years
• how fathers influence their children’s development
• the impact of air and chemical pollutants in early life
• which parental leave policies are best for parents with young children.
Cohort studies are now widespread across the world. Increasing focus on collaborations between cohorts.

9. What Born in Bradford is
A longitudinal birth cohort study of babies born
under the care of the Bradford Royal Infirmary
between 2007 and 2011.
• 12453 mothers: 13776 pregnancies: 13818
children : 3448 fathers
• Half of the families in BiB are in the poorest fifth
for England and Wales
Participants provide baseline data, biological
samples, permission to access routine
health/education data.

14.  Describe health and ill-health and their causes;
 Develop, design and evaluate interventions to promote
health;
 Provide a model for integrating research into practice
 Build and strengthen local research capacity in Bradford.

15. Who is involved
• BiB is based at the Bradford Institute for Health
Research.
• Executive Committee – Bradford Hospitals; Bradford,
Leeds, York Universities.
• University partners include : Bristol, Imperial, LSHTM,
Leeds Met, Loughborough, Durham, Manchester,
Edinburgh (in total 20) 12 international research
centres and European Networks.
• Funders include: NIHR; Medical and Environmental
Research Councils, Wellcome, EU Framework 6 and 7

16. Factors contributing to health and ill-health
• Social structures – poverty/ ethnicity / social class /
migration
• Social capital
• Access to health services and quality of health services
• Environments – housing / air / water quality
• Behaviour – food / smoking / alcohol
• Psychological – mood
• Physiology / metabolism
• Genes
Especially the relationship between all these

17. Data collected- baseline
• Demographic/socio-economic
• Family history, including migration history
• Lifestyle factors – smoking/drugs/alcohol/exercise
• Diet – modified food frequency + targeted questions re
certain foods
• Well being – GHQ 28
• Clinical: antenatal and medical histories; drugs; BP; weight;
U/S scans.
• Blood: GTT; insulin; DNA extraction
Nested Studies
additional data collected on sub groups within BiB

18. Comparing white British and Pakistani
origin families.
• Different patterns of
health related behavior
• Birth weight and growth
– Pakistani origin infants
lighter and shorter at
birth. Catch up by age 2
• SIDS – 4 times less likely
in Pakistani babies
• Birth defects/
congenital anomalies –
cousin marriage
doubles prevalence
from 3 to 6% in
Bradford
• low levels of vitamin D
in Pakistani mothers

19. Similarities in the cohort
• Similar take up of
antenatal care
• Considerable obesity in
pregnant women.
• Levels of initiating and
sustaining breast feeding
low
• High levels of eczema,
asthma and allergies
• High levels of acrylamide
in diets of pregnant
women
• High levels of health
problems identified by
teachers when children
start school
• High levels of physical
inactivity in children
• Similarities in reported
levels of positive attitudes
to living in the city.

20. Interventions – education/ information +
projects
• Advice to health
professionals re appropriate
growth rates
• SIDS – what is high risk
behaviour
• Health education/
promotion re cousin
marriage + accurate data
collection + plan care
provision
• Diabetes / vitamin D – pre
and early pregnancy advice
• Avoid chips and crisps.
• Air quality – information to
Public Health
• Improved communication
schools/health services
• Open up playgrounds – PiP
project
• Parenting programmes for
those at high risk re obesity

21. www.borninbradford.nhs.uk