Could Vitamin D Levels in Pregnant Women be Linked to Learning Disabilities?

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing Inequalities

Researchers looked at the data of over 800,000 children in Scotland to see whether there is a link between the time of year children are conceived in and learning disabilities

The Challenge

Previous studies suggest that there could be a link between autism and the time of year children are conceived. However, no research has been done into a possible connection with other learning disabilities.

The Research

Researchers from the University of Glasgow, the NHS and the Scottish Government linked two databases: The Scottish annual pupil census (2006-2011) and a maternity database that contains information about all women giving birth in Scottish hospitals. Through this data linkage they were able to find out when more than 800,000 children included in the study were born and whether they have a learning disability.

The Results

The research team found that 8.9% of children who had been conceived between January and March had learning disabilities. In contrast this figure was only 7.6% for children who had been conceived between July and September.

The Impact

In Scotland, there is insufficient sunlight in January to March for pregnant mothers to produce vitamin D. The researchers think that this lack of vitamin D could therefore be a cause for children conceived in winter being more likely to have a learning disability than children conceived in summer.

The results of this study show that if we could get rid of the seasonal differences, we could prevent 11% of cases of learning disabilities.

Although the study did not directly measure vitamin D, it remains perhaps the most likely explanation for the trend. If it is indeed the cause, it would greatly support the recommendation by the government that all pregnant women (and women who are trying to get pregnant) take vitamin D supplements.

 

Find out more about learning disabilities: www.mentalhealth.org.uk/learning-disabilities/

Mackay, D. F., Smith, G. C. S., Cooper, S., Wood, R., King, A., Clark, D. N., & Pell, J. P. (2016). Month of Conception and Learning Disabilities: A Record-Linkage Study of 801,592 Children. American Journal of Epidemiology, 184 (7), 485-493. https://doi.org/10.1093/aje/kww096 

Lead: Professor Jill Pell

 

Publications: Mackay, D. F., Smith, G. C. S., Cooper, S., Wood, R., King, A., Clark, D. N., & Pell, J. P. (2016). Month of Conception and Learning Disabilities: A Record-Linkage Study of 801,592 Children. American Journal of Epidemiology, 184 (7), 485-493.

 

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.


Did the smoking ban work?

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing Inequalities

By analyzing data, researchers at The Farr Institute have shown how the introduction of smoke-free areas in public places has led to a number of benefits to public health.

The Challenge

When policy changes are introduced by Government it is important to measure how effective they are and the impacts they have on society. One example of recent policy change is the introduction of smoking restrictions in public places. By comparing health outcomes before and after the smoking ban was introduced, it is possible to assess the effects it has had on the health of the population.

The Research

Scotland’s smoke-free legislation was passed in 2006. A team of scientists and clinicians from across the UK developed a detailed programme of research using data from sources such as hospitals, maternity units, quit-smoking clinics and various Government departments and agencies. Researchers used this information to evaluate the impact that the public smoking ban has had on people’s health by comparing the data from before and after the policy was introduced.

The Results

The studies showed that the smoking ban has had a positive impact on the health of the public. In particular, the research showed improvements in the rates of childhood asthma (hospital admissions reduced by 18%), pregnancy complications (preterm births reduced by more than 10%) and strokes caused by blocked blood vessels to the brain (10% drop over the first 20 months after the ban). It also showed that more people have attempted to quit smoking since the legislation was introduced.

The Impact

By using data in research, this programme of studies showed that smoke-free legislation in Scotland was associated with a number of public health benefits. It showed that this change in policy reduced rates of respiratory disease, producing
fewer hospital admissions for childhood asthma. The results also showed that introduction of the smoking ban reduced the risk of babies being born prematurely and also reduced the number of babies born smaller than expected. Results
also showed a reduction in heart attacks and strokes. In addition, it demonstrated a dramatic increase in the number of people who tried to stop smoking at the beginning of 2006 in anticipation of the smoking-ban coming into place. Only by collecting and using data about Scotland’s population could researchers unveil the benefits that smoke-free legislation has had on the health of the country. Research
like this can inform and provide evidence to Government and policy makers, proving that changes in legislation can have significant positive impacts on society and public health. The smoking ban has improved the health of the nation.

For more information on the benefits of stopping smoking and advice on how to quit, please visit the NHS advice pages:
www.nhs.uk/livewell/smoking/Pages/stopsmokingnewhome.aspx

Lead: Professor Jill Pell

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.


Research Using Medical Records Suggests That Aspirin May Help Women with Breast Cancer

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing InequalitiesPrecision Medicine and Chronic Disease

By analysing information collected by the NHS, researchers were able to provide evidence that suggests that aspirin could improve survival of women diagnosed with breast cancer, leading to a UK-wide clinical trial.

The Challenge

People often have more than one disease requiring long term use of medication. Occasionally this can result in clinicians and researchers gathering information that suggests that a medicine used to treat one disease may also be beneficial in treating another disease. A few small research studies started to suggest that patients who took aspirin after they had been diagnosed and treated for breast cancer had better survival outcomes than those who were not given aspirin as part of their medication. However, not all studies showed this link. Researchers from the Universities of Dundee and Glasgow used data from the 400,000 population of Tayside in Scotland to see if they could find evidence to support this connection.

The Research

The NHS in Scotland collects information about people who are diagnosed with and lose their lives to cancer each year, as well as the drugs they are prescribed. This information can be linked and used by researchers to investigate whether a group of patients given a particular drug are more likely to survive compared to a group of patients who are not taking the drug.

In this study the researchers compared women with breast cancer who were taking aspirin for another medical condition and patients who were not taking aspirin. The researchers obtained ethical approval to study the records of women within Tayside who were diagnosed with breast cancer between 1998 and 2008. The health records provided information on the type of breast cancer, the treatment patients received and whether the patients had died.

The Results

The study followed women until they passed away or for an average of over 5 and a half years. It showed that women who took aspirin after their breast cancer diagnosis were 47% less likely to die at any given point in time than those who were not taking aspirin. The researchers did not have access to the medical information that would have allowed them to know why patients were given aspirin, but in general the patients were prescribed a low dose (lower than over the counter aspirin used for pain relief) which is often given to people who have had heart attacks or strokes.

The Impact

Although this study provided further evidence supporting the theory that aspirin helps survival in women diagnosed with breast cancer, it is not conclusive proof that giving cancer patients aspirin will definitely help their survival. It may be that there’s something else more common in women who take aspirin after having had breast cancer that makes them live longer. However, because this is one of a number of studies which has shown the link between taking aspirin and longer survival after breast cancer diagnosis, Cancer Research UK are now sponsoring a UK-wide clinical trial to establish whether adding a low dose of aspirin to other breast cancer medications can improve survival.

To find out more about the Cancer Research UK trial, visit www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-whether-aspirin-can-stop-cancer-coming-back-after-treatment-add-aspirin.

University of Glasgow Lead: Professor Colin McCowan

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.


Does Health at Birth Affect Educational Outcomes in Later Life?

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing Inequalities

Led by the University of Glasgow, investigators at The Farr Institute have discovered links between the delivery and health of newborn babies and performance in education later on in life.

The Challenge

How babies are born and birth weight are examples of data routinely recorded by maternity staff about mothers and their babies.

Until recently, how birth and early-life events relate to educational outcomes in later life has been little understood. Identifying these links is complicated because information about health and education are recorded in different ways by different organisations. Only by linking data together were scientists able to explore connections between birth, a baby’s health and outcomes of education.

The Research

A team of researchers undertook the complex and time-consuming task of linking sets of data from the health and education sectors together.  This was done in a completely safe, secure and trustworthy way which, while protecting the data of individuals, allowed scientists to study the patterns that emerged. By linking data about mothers and babies from maternity records to data from schools and examination results, the researchers could look at how pregnancy, birth and other early childhood factors affect educational performance later in life.

The Results

Maternity staff evaluate a baby’s health within 5 minutes of birth to check they are physically healthy and to see if any medical or emergency care is needed. This is recorded as something called the APGAR score. By linking data, the research showed that a baby’s APGAR score and how birth is managed can affect the outcomes of education and health in the long term.

One particular finding suggested that babies in the breech position delivered by scheduled Caesarean section have better long-term educational outcomes than those born naturally. Interestingly, the data also showed that an increasing number of babies who are not in the breech position are being delivered by scheduled Caesarean section.

It was also found that delivering a baby even 1 or 2 weeks early can increase the likelihood of an individual requiring support in the course of their education.

The Impact

These studies demonstrated the benefits of being able to link health and education data together in order to study the connection between events and outcomes in people’s lives. The findings from these studies will help to inform pregnant women and their doctors of the long term outcomes associated with different options for child birth.

To find out more about The Farr Institute’s work in this area visit www.farrinstitute.org/research-education/research/child-and-maternal-health 

University of Glasgow Lead: Dr Daniel F MacKay

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.


How Good are Statins at Preventing Heart Disease?

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing InequalitiesPrecision Medicine and Chronic Disease

By using data from electronic health records, researchers at The Farr Institute gathered evidence to show how effective statins are in preventing heart disease and reducing costs to the NHS.

The Challenge

Over half of UK adults aged over 45 years have high cholesterol levels. High cholesterol levels are known to increase the likelihood of a heart attack or stroke. Clinical trials have demonstrated that lowering cholesterol lowers the risk of a heart attack or stroke. Statins are a drug which reduce cholesterol. They were originally
given to patients who had suffered a heart attack or stroke to reduce the chances of another attack. In the 1990s 6,600 men living in the West of Scotland participated in a large clinical trial called The West of Scotland Coronary Prevention Study (WOSCOPS). It finished in 1995 and showed that treatment with a statin (pravastatin) prevented heart attacks in people who had not had a heart attack, but had high cholesterol levels and hence were at higher risk of having a heart attack. After the study finished, the electronic health record system in Scotland allowed researchers to follow the participants for a further 10 years, demonstrating the benefits to both the patients and the health service in prescribing statins to prevent heart attacks and strokes.

The Research

The original WOSCOPS trial ran for 5 years and compared the rates of first time heart attacks in two groups of men. One group received a placebo tablet and the second group received a daily dose of pravastatin. The patients were then followed for a further 10 years through electronic hospital records, which record the reason for admission, treatments in hospital and national death records.

The Results

The WOSCOPS trial demonstrated that 5 years of treatment with pravastatin reduced first time heart attacks or death from coronary heart disease in middle aged men by 31%. Ten years later the results show there is still a benefit to taking a statin to prevent heart disease. There was a one-third reduction in the risk of a heart attack and similar reductions in the need for procedures which restore blood flow to the heart when the blood vessels get blocked and a previously unseen drop in hospital admissions due to heart failure. There was no difference in hospital admissions for other diseases, suggesting that the pravastatin was safe to take over this period. The data estimates that for every 1,000 patients treated for 5 years with a statin this would save the NHS £710,000 over 15 years. As well as the reduction in costs due to fewer surgery requirements, there was also a significant reduction in the number of days spent in hospital.

The Impact

The use of statins has transformed the healthcare of patients at risk from heart disease and stroke. They provide a cost-effective prevention strategy for the NHS and have made a major contribution to the reduction in deaths due to heart disease in both Europe and the USA. Clinical trials like WOSCOPs and the ability to gather evidence of the effectiveness of statins by using electronic health record data have provided evidence of safety and benefits in the long term. This has led to the development of international clinical guidelines and strategies to lower cholesterol to treat heart disease and stroke.

For further information on heart disease including steps you can take to prevent heart disease, explanations of treatments, how to support people with heart disease and the latest research please visit the British Heart Foundation website, www.bhf.org.uk

Lead: Professor Ian Ford

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.


Using Data to Find Out About the Mental Health of Military Veterans

IHW Research Theme: Data Science, Inactive - Determinants of health and health inequalities

UoG Beacon: Addressing Inequalities

Farr Institute researchers at the University of Glasgow studied the medical records of people in Scotland to compare the health of military personnel to the rest of the population.

The Challenge

Most research into understanding the health of military veterans compared to the general population looks at the health of veterans who served in a particular conflict or at single medical conditions. The results of such studies can’t always be applied to all military veterans and the results do not take into account factors such as length of service, changes in health promotion within the military and social changes such as attitudes to smoking and alcohol consumption. A more complete picture of the health of military veterans can be achieved by linking multiple NHS Scotland records, allowing researchers to study the health of veterans after their military service.

The Research

Researchers from the University of Glasgow were able to identify people in Scotland who had served in the military by the medical records held by their GP surgeries. The team found more than 56,000 veterans who were born between 1945 and 1985. These records were then virtually gathered together to form a sub-group of military personnel from the Scottish population that researchers could study in more detail. To do this, information about hospital admissions, mental healthcare, where people lived and death certificates were linked together in a secure way which protected the identity and privacy of individuals. A larger virtual group was then created including nearly 173,000 individuals who had never served in the military but matched the veterans in age, sex and the area in which they lived. The team then studied and compared the medical histories of both groups, looking at conditions such as mental illness, heart disease and alcohol related illness.

The Results

The Scottish Veterans Health Study has demonstrated that while older veterans (born 1945-1959) may have had overall poorer health than those who had not served in the military, younger veterans had similar if not better overall health than civilians. One of the reasons for this could be due to the military beginning to promote a healthier lifestyle during service years, encouraging a decrease in risk factors such as smoking and alcohol consumption, and increasing the fitness of soldiers. There was no indication that veterans who served their full term in the military suffered from mental illness more than civilians. However, veterans who left the military early were at higher risk of mental illness.

The Impact

The methods used in this research to create a virtual sub-group of the population for scientists to study can be applied to many areas of health research. Studying veterans as a population in this way could help improve our knowledge about the health of military personnel and whether they are at higher risk of developing particular diseases compared to the rest of the population. It is also possible to study the impact that health promotion initiatives such as anti-smoking campaigns and educating about the effects of alcohol misuse have during military training and service. By using data in research, the team has been able improve our understanding of the health of veterans in Scotland and how care can be improved to support them.

To find out more about health services for veterans in Scotland, visit www.veterans-assist.org/home/veteran-support/health

Lead: Professor Jill Pell

This case study is featured in the Farr Institute '100 Ways of Using Data to Make Lives Better' series.