Born in BradfordJohn WrightYCCSA Seminar

Growing up in Bradford

High infant mortality

High rates of disability

High rates of asthma

Impending diabetes epidemic

Childhood obesity

Social change

Cohort Studies

N O N – R A N D O M I Z E D

Disease No Disease Disease No Disease

Defined Population

Exposed Non-exposed

De Stavola et al 2006 AJE

SOCIO-ECONOMIC• Deprivation• Social capital • Education

GENETIC• Consanguinity

MOTHER

ETHNICITY

LIFESTYLE• Nutrition/diet• Smoking• Alcohol

ENVIRONMENT• Air pollution• Chemical exposures• Water

MEDICAL• Depression/anxiety• Diabetes• Hypertension• Infections• Obesity

BIOLOGICAL • Nutritional biomarkers• Metabolic biomarkers• Vitamin D

EXPOSURES

OUTCOMES

Birth weightAnthropometryPre-eclampsia/diabetesCongenital anomaliesKidney volume

GrowthObesity/OverweightAnthropometryImmune function

GrowthObesity/OverweightAllergyWell-beingEducation attainment

CHDDiabetesHypertensionObesity

LIFE COURSEBIRTH

INFANT

ETHNICITY

LIFESTYLE• Breastfeeding• Diet• Physical activity• Infant feeding/weaning• Infant care practices

ENVIRONMENT• Housing• Recreation facilities• Shops

MEDICAL• Hospital/GP attendance• Infections

SOCIO-ECONOMIC

GENETIC

BIOLOGICAL

CHILD

ETHNICITY

LIFESTYLE• Diet• Physical activity• Screen viewing

ENVIRONMENT• Housing• Recreation facilities• Green spaces

MEDICAL

SOCIO-CULTURAL

ADULT

ETHNICITY

LIFESTYLE

ENVIRONMENT

MEDICAL

SOCIO-CULTURAL

Data collected

Demographic/socio-economic

Family history

Lifestyle factors – smoking/drugs/alcohol

Diet

Well being – GHQ 28

Social Capital

Clinical: antenatal and medical histories; drugs; BP; weight; U/S scans.

Blood: routine; GTT; insulin; DNA extraction

BiB Biobank

BiB Database

Country of birth

UK born Pakistani womenPakistani women born in Pakistani who moved to the UK aged 5 or underPakistani women born in Pakistani who moved to the UK aged over 5

0

2

4

6

8

10

12

0 5 10 15 20 25 30 35 40

Age moved to the UK

Per

cen

tag

e

Women’s employment status

Women's employment status

0

10

20

30

40

50

60

70

80

90

100

Currently employed Previously employed Never employed

Per

cen

tag

e

White Pakistani - UK born Pakistani - moved <=5yrs Pakistani - moved >5yrs

02

46

80

24

68

0 20 40 60 80 0 20 40 60 80

White English speaking Pakistani

Mirpuri speaking Pakistani Urdu speaking Pakistani

Per

cent

GHQ-28 Total Score (Likert Scoring)Graphs by Ethnicity and Language

Mental health

42.3% 53.7%

29.4% 37.7%

Sleep-sharing by ethnicity

Smoking and alcohol

Smoking        

Reference Comparison

MeanDifferencegrams 95% C.I. p-value

Non-smokerDecreasing or quitting

throughout -80 -129 to -31 <0.01

 Continuing smoking

throughout -240 -324 to -156 <0.01

Alcohol        

Reference Comparison

MeanDifferencegrams 95% C.I. p-value

Non-drinker

Decreasing or stopping drinking throughout 19 -32 to 71 0.46

 Continuing drinking

throughout -7 -75 to 62 0.85

Exposures of interest

Polycyclic hydrocarbons

Heterocyclic amines

Acrylamides

Nitrosamines

Mycotoxins (Deoxynivalenol)

Organochlorins (PCBs, dioxin)

DNA reactive aldehydes

Alcohols

05

01

001

502

00A

vera

ge

of a

ll g

lyci

dam

ide

addu

cts

(pm

ol/g

glo

bin

)

0 1 2 3 4

05

01

001

502

00A

vera

ge

of a

ll a

cryl

am

ide

addu

cts

(pm

ol/g

glo

bin

)

0 1 2 3 4

2,0

003

,000

4,0

005

,000

Bir

th w

eigh

t

0 1 2 3 4

n=238 n=216 n=244 n=189 n=217

Acrylamide adducts (AA-Hb, pmol/g Hb), glycidamide adducts (GA-Hb) and birth weight (grams) by country

Birth weight

AA-Hb

GA-Hb

DBPs – spatial and temporal variation in the study area

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

2006 2007 2008

Year and Month

TT

HM

(m

icro

g/l

)

1

2

3

4

5

6

7

8

• Little spatial variation in TTHM concentrations in the Bradford region (Fig. 1)

• Clear pattern of seasonal variation – TTHM concentrations peak in late summer (Fig.2)

Fig. 1 Modelled TTHM averaged over 2006-2008 for 8 WSZs

Fig.2 Modelled TTHM over 2006-2008 for each WSZ

Monitoring Nitrogen Oxides• Three 2-weekly monitoring

periods (summer, winter

and intermediate)

during 2009

• 40 NOx sites (using Ogawa

badge) at Traffic,

Urban Background and

Rural Background sites

Keighley

Bingley

Bradford

NO2 Adjusted NOx AdjustedSite type N Min Max Mean Min Max Mean

Traffic 14 19.4 36.7 28.6 33.6 79.9 55.7Urban Background 24 17.2 34.1 24.1 25.1 59.1 38.4Rural Background 2 16.7 17.0 16.9 22.4 24.7 23.5

ESCAPE NO2 predictions

Cyrrillic

Adjusted mean birthweight difference (95% CI) by ethnic & generation group relative to White British infants

-300

-250

-200

-150

-100

-50

0

50

Pakistani (all) Pakistani (1) Pakistani (2) Pakistani (3) Pakistani (4) Pakistani (5)

Ad

juste

d m

ean

bir

thw

eig

ht

dif

fere

nce (

g)

Growth faltering v WHO 2006

Vitamin D status and ethnic origin

12

34

5lo

g to

tal 2

5(O

H)D

South Asian White European Other

Seroprevalence of herpes virus infection

Seroprevalence (%)

n CMV EBV VZV

White, UK born 350 48.6 93.7 94.8

Asian, UK born 300 89.3 94.3 95.0

Asian, S. Asia born 299 98.3 92.6 89.6

p<0.0001 p=0.64 p=0.003

Atopy

14 schools

155 children tested

Mean age at test: 5.3 years (range 4.6 – 6.2)

42 children, 27% atopic

(95% CI 20 – 35)

Based on 2mm weal size: 52 children, 34% atopic (95% CI 26 – 42)

First 125 BradCAS cases: Consanguinity

Consanguinity BiB cohort(%)

BradCAS recruits (%)

No 6753 (70.4)

68 (58.8)

Yes 2843 (29.6)

57 (45.2)

Total 9596 125

In the BradCAS cohort there is an excess of births which are the product of a consanguineous union.

Consanguinity overall OR 1.98 (95% CI 1.4-2.8)

Impact of BiB

Structure Process Outcome

Awareness raising

Capacity building

NHS infrastructure

Communities of practice

Better measurement

General practice profiles

Congenital anomalies register

Evidence base

Diabetes detection

Promoting healthier lifestyles?

Has being part of the Born in Bradford project made you more aware of the health of you and your child?

71%

Has being part of Born in Bradford encouraged you to adopt a healthier life style?

61%