This project will address the question of health inequalities, by addressing the relationships between measures of socio-economic deprivation and respiratory health, particularly wheezing illnesses, asthma and lung function.The first part of the study will focus on the detailed information on respiratory health and socio-economic factors in the Avon Longitudinal Study of Parents and Children (ALSPAC) to determine the association of socio-economic deprivation and respiratory outcomes during childhood.We will further investigate these associations by attempting to identify explanatory variables, including lifestyle (smoking, diet) and environmental exposures.Observed associations will then be examined using a lifecourse epidemiological approach to investigate whether associations that we observe in a contemporary population of children (ALSPAC) are reproducible across previous generations in the United Kingdom and whether deprivation in childhood is associated with adult respiratory outcomes, independently of adult socio-economic status.In turn, this will allow us to explore the possible effects of social mobility on adult respiratory health. The project brings together expertise on the analysis of inequalities in health from an economics perspective, with a focus on measures of access to resources, and the exploitation of dynamics in data and the use of GIS tools to map local features to individuals (in the Department of Economics), childhood respiratory epidemiology, including assessment of asthma and lung function in a longitudinal birth cohort sample (Department of Community-based Medicine) and the multidisciplinary specialty of lifecourse epidemiology, including access to archived information on other existing cohorts (Department of Social Medicine).Therefore, this is a unique opportunity to build a global, comprehensive picture of the factors associated with socio-economic deprivation in the U.K. and their potential effects on an important aspect of public health.

Obstructive respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD) are among the commonest chronic health problems of children and adults in the United Kingdom. However, a review of the evidence on inequalities in Britain did not mentionasthma as a health issue related to poverty. Within countries there have been studies that have examined the relationship between socio-economic status and prevalence of asthma. While there does appear to be a consistent relationship between allergy prevalence and high socio-economic status, there is conflicting evidence with regard to asthma with studies showing increased or decreased prevalence in higher socio-economic groups and others showing no socio-economic gradient. However, one of the problems of interpreting these studies is that many of them are based on cross-sectional surveys and results may be inconsistent across time. For example, we have previously demonstrated differences in social factors associated with wheeze between infants and adults. This may relate to differentpathological aetiologies of wheezing in these two populations.Wheezing in infancy is associated with respiratory tract infection on a background of abnormal airway development, as evidenced by reduced lung function shortlyafter birth. Social factors, including exposure to tobacco smoke, have been demonstrated to be strongly associated with reduced airway function in infancy and a tendency to wheeze in the first few years after birth and factors associated with deprivation, such as crowded living conditions, larger family size and a reduced tendency to breast feeding will tend to increase the risk of respiratory infections. Although wheezing tends to resolve in the majority of these children by the age of 3 years, there is increasing interest in the long-term implications of impaired lung function in infancy and the possible relationship with COPD in adult life. Although COPD is generally regarded as a smoking-related illness, only a minority of active smokers develop the condition and, in observational studies that have examined early life factors, these have been shown to have a greater effect on COPD mortality than active smoking in later life. Therefore, in order to fully understand the nature of associations between markers of socio-economic deprivation and respiratory health and diseases, it is necessary to design studies that have the capacity to examine short and long term outcomes, preferably in the context of a longitudinal cohort design. The Avon Longitudinal Study of Parents and Children is a birth cohort study that has followed a population of children, recruited during their mothers' pregnancies with expected dates of delivery between April 1991 and December 1992. The study has included repeat questionnaires about respiratory symptoms at approximately annual intervals since birth and has objective measurements of lung function at 8 1/2 years of age. During the course of the proposed project, a further measurement of lung function will be available at 15 1/2 years (MRC funded). The ALSPAC study has also collected detailed information on lifestyle and environment (housing type, type of heating/cooking used, reported damp or mould in the home, household cleaning product use, parental smoking, and detailed dietary diaries from the mother and child). This presents the opportunity to carry out a uniquely detailed study of socio-economic influences on respiratory symptoms and function from birth to adolescence. To address the longer term respiratory health questions, we will use the approach of lifecourse epidemiology to investigate exposures at different stages of development that may contribute to the risk of diseases in adults, either by accumulation of exposure over time or by exposures acting at critical periods of development, or by interactions of these. The Department of Social Medicine, University of Bristol has extensive expertise in lifecourse epidemiological approaches using a combination of contemporary and historical cohort studies. We aim to study the Boyd-Orr cohort which was based on the Carnegie survey of diet and health (1937-9) of 4973 children and has information on socio-economic factors, diet and growth in childhood and respiratory follow up including MRC respiratory questionnaire responses and spirometry. We would also seek to collaborate with the 1958 and 1970 British birth cohort studies, which have also collected information on respiratory outcomes.