bin b presentation27sept07
DESCRIPTION
Born in BradfordTRANSCRIPT
Born In BradfordNeil Small
Professor of Health Research
School of Health StudiesUniversity of Bradford
25 Trinity Road, Bradford, BD5 OBB
Tel: 01274 236456 Fax: 01274 236458
Email: [email protected]/acad/health/research/pcg
.. What a cohort study is and why we are conducting one
.. 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 yearsMillennium cohort – 19000 babies born in 2000
• ALSPAC – Avon (Bristol) 14000 children born in 1991/2
Why Bradford?
• Diverse population
• Stable community
• One maternity unit
• Integrated health services
• Connected IT
• Enthusiasm
• Development of research infrastructure
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% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%
0 to 4
5 to 9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
45 to 49
50 to 54
55 to 59
60 to 64
65 to 69
70 to 74
75 to 79
80 to 84
85 plus
Male Female England & Wales
0
1
2
3
4
5
6
7
8
9
10
1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003
Rate
per
100
0 liv
e bir
ths
Bradford England & Wales
Infant Mortality Rate, Bradford and England and Wales
0
2
4
6
8
10
12
14
1993-1997 1994-1998 1995-1999 1996-2000 1997-2001 1998-2002 1999-2003
Rate
per
100
0 liv
e bi
rths
Most deprived
2nd most deprived
3rd most deprived
2nd least deprived
Least deprived
Infant Mortality by Deprivation Quintile within Bradford1993-97 to 1999-03
Comparative Infant Mortality Rates for Areas with Similar Populations to Bradford
Infant Mortality Rate
0
2
4
6
8
10
12
14
16
18
1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002
Rat
e
Kirklees MCDBlackburn with
Darwen UAPendle CDPreston CD England and
WalesBradford MCD
Comparative Infant Mortality Rates for Areas with Similar Levels of Deprivation
Infant Mortality Rate
0
2
4
6
8
10
12
1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002 1999-2001 2000-2002
Rat
e
Bradford MCD Rochdale MCD Mansfield CDDoncaster MCDLeicester UA England and Wales
Low birth weight (less than 2500g) rate by ward 1993 -
2003
MATERNAL
DIET
FETAL
GENOME
UTEROPLACENTAL BLOOD FLOW
PLACENTAL TRANSFER
N u t r i e n t d e m a n d e x c e e d s s u p p l y
F E T A L U N D E R N U T R I T I O N
BRAIN SPARING ALTERED BODY COMPOSITION
DOWN REGULATION OF GROWTH
EARLY MATURATION
IMPAIRED DEVELOPMENT: BLOOD VESSELS, LIVER, KIDNEYS, PANCREAS
INSULIN/IGF-1 SECRETION AND SENSITIVITY
CORTISOL MUSCLE
HYPERLIPIDAEMIAHYPERTENSION
CENTRALOBESITY
INSULINRESISTANCE
Type 2 diabetes and CHD
Visual impairment
58% Pakistani children vs 29% White British children
Schwarz et al. Eye 2002;16:S30-34
Deafness
4.7 per 1000 Pakistani children vs 1.4 per 1000 others
Parry G. BACDA report 1996
Cerebral Palsy
5.48 per 1000 in Pakistani children vs 3.18 per 1000 in others
Sinha et al Dev Med Child Neurol 1997 39:259-262
Childhood disability
District Number of cases
(total 736)
Bradford 50
Birmingham 31
East London & City 25
East Riding 22
Berkshire 19
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)
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.
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.
– 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/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
Progress so far• Community awareness• NHS support• IT systems• Questionnaire design• Biobank • Advocacy committee• Fundraising• Feasibility study• Pilot phase
Benefits.
• Full use of routinelycollected 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”