Deprivation, ethnicity and health differences in the Born in Bradford study

Neil Small,Professor of Health Research,

School of Health Studies, University of Bradford

N.A.Small@bradford.ac.ukhttp://www.brad.ac.uk/health/research/research-staff-profiles/neil-small.php

Bradford local health profile Public Health

Observatory England 2011

• Life expectancy – Men born in the district 76.4 (England average 78.3) : Women 80.4 (82.3)

• Comparing least and most deprived areas of Bradford: Men – 11.9 years more: women 7.2 years more.

• Democratic Republic of Congo 100• Nigeria 78• Kenya 49• Pakistan 69• India 44• Bangladesh 33• Sri Lanka 9• USA 6• UK 4• Sweden 2(World Bank, World Development Indicators 2014)

Infant mortality – worldwide deaths before age 1

per 1000 live births

Infant mortality rates in most deprived quintile , Bradford District, Region and England during 2007-09 to 2010- 2012Source: Public Health Analysis Team City of Bradford MetropolitanDistrict Council

Year Bradford MostDeprivedQuintile

Bradfordrate

Yorkshire &Humber

England

2007-2009 10.6 8.1 5.3 4.6

2008-2010 10.2 8.0 5.4 4.6

2009-2011 9.0 7.5 5.2 4.4

2010-2012 7.8 7.0 4.8 4.3

% Change -26.7 -13.1 -9.4 -6.5

Cause of death by ethnicity, 2000-2009 Infant Mortality Analysis Update 2011, NHS Bradford and Airedale , Dance J. et al

Congenital AnomaliesImmaturity

0 2 4 6 8 10 12 14

Other

Pakistani 2nd gen

Pakistani 1st gen

White

Mortality rate per 1000 births

Other specific conditions

Other conditions

External conditions

Immaturity related conditions

Asphyxia, anoxia or trauma

Antepartum infections

Sudden infant deaths

Infections

Congenital anomalies

Existing birth cohort studiesExamples in UK:

National Survey of Health and Development – a representative sample of 5362 men and women who were born in March 1946.

ALSPAC – Avon (Bristol) 14000 children born in 1991/2

Millennium cohort – 19000 babies born in 2000

LIFE study – funded by ESRC/MRC– based at UCL the study will collect social, heath and biological information on 80,000 babies born across the UK between 2014-18 and their families• why some babies develop asthma, eczema and food allergies while others do not• how children get ready for learning at school during their preschool years• how fathers influence their children’s development• the impact of air and chemical pollutants in early life• which parental leave policies are best for parents with young children.

Cohort studies are now widespread across the world. Increasing focus on collaborations between cohorts.

What Born in Bradford is

A longitudinal birth cohort study of babies born under the care of the Bradford Royal Infirmary between 2007 and 2011.

• 12453 mothers: 13776 pregnancies: 13818 children : 3448 fathers

• Half of the families in BiB are in the poorest fifth for England and WalesParticipants provide baseline data, biological samples, permission to access routine health/education data.

Describe health and ill-health and their causes; Develop, design and evaluate interventions to promote

health; Provide a model for integrating research into practice Build and strengthen local research capacity in Bradford.

Who is involved

• BiB is based at the Bradford Institute for Health Research.

• Executive Committee – Bradford Hospitals; Bradford, Leeds, York Universities.

• University partners include : Bristol, Imperial, LSHTM, Leeds Met, Loughborough, Durham, Manchester, Edinburgh (in total 20) 12 international research centres and European Networks.

• Funders include: NIHR; Medical and Environmental Research Councils, Wellcome, EU Framework 6 and 7

Factors contributing to health and ill-health

• Social structures – poverty/ ethnicity / social class / migration

• Social capital • Access to health services and quality of health services• Environments – housing / air / water quality• Behaviour – food / smoking / alcohol• Psychological – mood• Physiology / metabolism• Genes

Especially the relationship between all these

Data collected- baseline• Demographic/socio-economic• Family history, including migration history• Lifestyle factors – smoking/drugs/alcohol/exercise• Diet – modified food frequency + targeted questions re certain

foods• Well being – GHQ 28• Clinical: antenatal and medical histories; drugs; BP; weight; U/S

scans.• Blood: GTT; insulin; DNA extraction

Nested Studies additional data collected on sub groups within BiB

Comparing white British and Pakistani origin families.

• Different patterns of health related behavior

• Birth weight and growth – Pakistani origin infants lighter and shorter at birth. Catch up by age 2

• SIDS – 4 times less likely in Pakistani babies

• Birth defects/ congenital anomalies – cousin marriage doubles prevalence from 3 to 6% in Bradford

• low levels of vitamin D in Pakistani mothers

Similarities in the cohort

• Similar take up of antenatal care

• Considerable obesity in pregnant women.

• Levels of initiating and sustaining breast feeding low

• High levels of eczema, asthma and allergies

• High levels of acrylamide in diets of pregnant women

• High levels of health problems identified by teachers when children start school

• High levels of physical inactivity in children

• Similarities in reported levels of positive attitudes to living in the city.

Interventions – education/ information + projects

• Advice to health professionals re appropriate growth rates

• SIDS – what is high risk behaviour

• Health education/ promotion re cousin marriage + accurate data collection + plan care provision

• Diabetes / vitamin D – pre and early pregnancy advice

• Avoid chips and crisps.• Air quality – information to

Public Health• Improved communication

schools/health services• Open up playgrounds – PiP

project• Parenting programmes for

those at high risk re obesity

www.borninbradford.nhs.uk