3. Born In Bradford Neil Small Professor of Health Research
School of Health Studies
University of Bradford
25 Trinity Road,
Bradford, BD5 OBB
Tel: Fax:

4. .. 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

5. 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

6. 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 – babies born in 2000
ALSPAC – Avon (Bristol) children born in 1991/2

8. 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

10. Infant Mortality Rate, Bradford and England and Wales

11. Infant Mortality by Deprivation Quintile within Bradfordto

13. 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 % 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

14. 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)

15. 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

16. 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.

17. 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

18. 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.

20. 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

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

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

24. 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.

25. 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”