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

.. Why we are conducting a cohort study .. Why Bradford is a good place to do such a study .. Study objectives .. What data we will collect and when Study Benefits Study Challenges

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 profile If you do it in one place you can link findings with service provision

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

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

Infant Mortality Rate, Bradford and England and Wales

Infant Mortality by Deprivation Quintile within Bradford 1993-97 to 1999-03

Low birth weight (less than 2500g) rate by ward 1993 - 2003 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 Low birth weight (less than 2500g) rate by ward 1993 - 2003

Comparative Infant Mortality Rates for Areas with Similar Populations to Bradford 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)

Comparative Infant Mortality Rates for Areas with Similar Levels of Deprivation 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

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 24 months (potential numbers – 11000) 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.

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

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. Intervention trials – Vit D, fish oil supplementation, public health interventions To describe social and ethnic differences in health status and the effects of ethnic density on health status and pregnancy outcomes.

Data collected Demographic/socio-economic Family history Lifestyle factors – smoking/drugs/alcohol Diet – 24 hour recall Well being – GHQ 28/EPNQ Social Capital Clinical: antenatal and medical histories; drugs; BP; weight; U/S scans. Blood: routine; GTT; insulin; DNA extraction

Why Bradford? Diverse population Stable community One maternity unit Integrated health services Connected IT Enthusiasm Development of research infrastructure

Progress so far Community awareness NHS support IT systems Questionnaire design Biobank Advocacy committee Fundraising

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.

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”