1. The Born in Bradford project With focus on congenital and rare genetic conditions Peter Corry Sept 2017

2. Dark Satanic Mills?

3. Bradford City Hall in 2017

4. Summary of talk Background to children’s health in Bradford
The Born in Bradford project
Findings about congenital conditions

5. Bradford demographics
Population ,000
Children (up to 18) ,000
Annual births ,000
Pakistani origin births %
Infant Mortality Rate /1,000
Infant Mortality Rate (UK) /1,000

6. Migration to Bradford
19th Cent. From countryside, Ireland and some Germans
1940s. From Eastern Europe and Italy
1950s – 1990s. From Indian subcontinent, with some from West Indies/East Africa
2000s. From Eastern Europe, asylum seekers and others

7. Health and social issues.
Relative socio-economic deprivation
Old overcrowded housing stock
Relatively limited access to well paid jobs
Relatively poor academic achievement
Young growing population
Reduced life expectancy

8. 2003 Infant Mortality Rate
Bradford 9.0/1000
UK /1000
Bfd White British 7.1/1000
Bfd Pakistani 12.9/1000
Sweden 2.57/1000
USA 5.98/1000
Pakistan /1000
Afghanistan /1000

10. Born in Bradford
13,773 mothers recruited in pregnancy at weeks gestation
13, 858 babies (live and stillbirths)
Born between 2007 and 2011
Only if registering at Bradford Royal Infirmary
Excludes: those choosing to deliver elsewhere, those having termination after ante natal diagnosis

11. Strong community involvement

12. Born in Bradford research.
Nutrition and diet
Growth + obesity
Exercise
Asthma
Environment
Smoking and alcohol
Social gradients: health
Mental health
Sudden infant death
Squints
Progress in school
Health in school
Impact of interventions
Rates of consultations
Congenital conditions

13. Some issues Standing desks in classrooms TV and computers
Access to outside play and parks
Adverse effects near busy roads
Co-sleeping
Health links to nicotine and alcohol
High rates of congenital/genetic conditions

14. Ethnic variation White British mothers % Pakistani mothers %
Smoke in pregnancy
Alcohol in pregnancy 43
Married
Living with father
Married to cousin <1
Smoke in pregnancy
Alcohol in pregnancy <1
Married
Living with father
Married to cousin

15. Increased prevalence in Bradford children of Pakistani heritage
Metabolic
Deafness
Congenital hearts
Haemoglobinopathies
Coagulation disorders
Many AR conditions
Neuromuscular
Microcephaly
Visual impairment
PCD
Skin conditions
Cerebral palsy
AR-autosomal recessive

16. BPSU study present
Progressive Intellectual and Neurological Deterioration
United Kingdom children
Bradford postcode children
(8% of UK total)
British Paediatric Surveillance Unit Bulletin Oct 2006

17. BPSU 2010 update Bradford (by postcode) 87 Birmingham 67
East London 42
Leeds
Median for UK district 9
Verity C, et al ADC (2010)

18. Neurodegenerative conditions in Bradford children (April 2010)
South Asian 47
White British 3
Slovak Roma 2
Total 52
CDC database

19. Microcephaly in Bradford
44 children
35 congenital, 9 postnatal
Congenital:
27 Pakistani
7 White British
1 Bangladeshi
Corry P, 2002 Community Genet.

20. Primary Ciliary Dyskinesia
19 Bradford children, 18 Pakistani and 1 Bangladeshi
Prevalence in Bfd Asian children: 1:2,265
Usual prevalence 1:10,000-30,000
Cystic fibrosis clinic now “PCD clinic”
O’Callaghan C et al, ADC (2010) 95:51-52.

21. Infant mortality rates due to congenital anomalies by ethnic group per 1,000 live births for babies born in England and Wales in 2005
Moser K, et al. Health Statistics Quarterly Autumn 2008; 39:

23. Congenital conditions
“A congenital anomaly is defined as any defect present at delivery, probably originating before birth, and includes structural, chromosomal, genetic and biochemical defects and malformations”.
BINOCAR - British and Irish Network of Congenital Anomaly Research Database

24. BiB congenital anomaly report
Bradford 305/10,000 livebirths
United Kingdom 165/10,000 livebirths
Consanguinity (all ethnicities) relative risk X 2.19
Age >34 (White British) relative risk X 1.83

25. Cousins and Clans
Consanguinity. A union between 2 people who are related as second cousin or closer.
Endogamy. A union between 2 people from the same group. (Tribe, religious sub-group, isolated community, class, etc.)

26. Some examples
Royalty
Geographically isolated (islands, Alpine valleys, rural Finland)
Religious groups (Amish, Ashkenazi Jews)
Rich magnates
Castes in India
It’s commoner than you think

27. Conclusions (1)
Within UK, rates of congenital conditions may vary significantly with different marriage patterns and increasing maternal age
Services need to be sensitive to our diverse population’s needs
Public Health needs to have accessible information available

28. Conclusions (2)
Knowledge gained though study of clusters of rare conditions may advance medical science
Collaboration with countries of origin may speed knowledge and benefit patients
Working together for our children may lead to better community cohesion.

29. Thank You

30. Deafness in Bradford children
2.3/1,000
Deafness in UK children:
1.0/1,000
Deafness in Bradford Asian children:
4.69/1,000
Deafness in Bradford non-Asian children:
1.38/1,000
Parry G, MSc 1995

31. Visual Impairment
High prevalence of visual impairment in Bradford Asian children
Schwarz K, Yeung S, Symons N, Bradbury J. Eye (2002) 16(5):530-4