 Good afternoon everyone and welcome to today's webinar which is aimed to introduce you to some of the survey data we have in the UK on biomarkers. My name is Deborah and I'm one of the user support team based at the UK Data Service up at the University of Essex. So this afternoon I'm going to talk very briefly about what we mean by biosocial research just to set the context for the rest of the webinar and then I'll move on to talking about biomarkers so what are they and I'll have a look at just a small number of the biomarkers that are available and we'll have a look at what they actually tell us and then I'll move on and I'll tell you exactly where these biomarker data can be found within studies done in the UK and I'll mention as part of that briefly about how to access those data and then I'll finish up with some resources. So let's think about biosocial research. Now really when we're talking about this what we're talking about is this idea of there being a dynamic interplay between our biology and the behaviors and experiences that we have across our lifetime and this interplay can work in two different directions. So we can move from social to biology and people refer to that as our experiences getting underneath our skin and it can move the other way so our biology can move outside of our skin to affect our social experiences and I'll talk about those in just a minute and then I'll talk about this idea of a nature versus nurture debate which has been around since time immemorial I suspect. Now the idea of this interplay and biosocial research is not new although it is new I think in terms of being a real area of policy interest but it's really been around for a very long time and I found this lovely quote in a blog which is available on the ESRC website from this guy you can see on the screen who is a physician in the 19th century so you can see that actually this idea isn't new. So what do we mean? So we talk about getting under the skin and this is really about how our social experiences get underneath the skin and what sort of biological pathways there are between social factors and our health and what we're talking about is the consequences of any adverse experiences that we have become biologically embedded and there's a number of ways of thinking of this people refer to the allostatic load and this is really the wear and tear on our bodies which can increase over time if we're exposed to chronic stress or repeated episodes of stress and it's thought that this allostatic load is a pathway to disease and the pathways can include our health behaviors and whether they change what sort of exercise and how we deal with stress for example so a common area of interest here is what sort of health effects disappear a personal experience if they have a long term unemployment or multiple spells of unemployment and as I mentioned we can go the other way so how does our biology, how do our genes interact with our environment so how does it get outside of our skin? It's well accepted that our mental and physical health is strongly related with our lifestyles and the sort of choices we make and also there's a real strong association found with social inequalities so it might be that we want to know whether we're predisposed to certain characteristics whether we're predisposed to develop certain conditions or medical problems and geneticists in this area have been using polygenic schools to have a look at the effects that our genes have on us so are people more at risk of developing a mental illness are some people more prone to substance abuse for example and really this goes to this idea of nature versus nurture and really it's a fantastic quote here again from a blog on the ESRC website really what biosocial research enables us to do is to understand what exactly it is in our social environment that we live in i.e. the nurture part of the equation that translates risk or nature into a specific outcome so that's just really to give you a flavor and a context of this sort of area of research so let's have a look at biomarkers what are they and what sort of things do they tell us what do they enable us to research now a biomarker quite simply is a characteristic which is objectively measured and evaluated they indicate either normal biological processes or pathogenic processes and they can also tell us about the responses that we have to therapeutic interventions for example taking medications now many surveys collect data about health but a lot of this health is self-reported now there may be some inaccuracies people may record things slightly inaccurately they may remember things inaccurately or they may not be aware for example that they have a condition that perhaps is not yet showing symptoms so the real value of biomarkers is that they are objective they're a very precise measurement of our health and illness they can help us to examine specific conditions even those that may not yet be diagnosed some people will have diabetes but it will show very little symptoms in the early stages and they may not yet be aware that they have that condition it can also help researchers to have a look at what risk factors are at play so what things can lead up to the development of a disease and as I mentioned we can have a look at how effective a new drug treatment might be there's quite a range of different biomarkers available and these are some of the ones that you will be able to find in UK sources of data now I'm going to have a look at a couple of these in more detail in just a minute and you can obviously download the slides if you want to have a look but these range from things that test the function of certain organs such as our liver and our kidneys we can have a look at biomarkers which enable us to have a look at our hormonal health we can have a look at things like anemia, inflammatory markers for example so let's have a look at a couple of these in more detail now one biomarker is C-reactive protein now this is a marker of inflammation so it's an acute phase protein and this protein rises in response to inflammation and it's part of the body's way of dealing with harmful stimulus so that might be an infection or injury for example it's a known risk factor or marker for a variety of different diseases such as cardiovascular disease and cancer but it's also found to be associated with our social position and also with the aging process now these are the sort of levels which are used to denote good levels or unhealthy levels so we've got if you have a level of between 3 to 10 micrograms per litre of blood this is called systemic inflammation and in general levels of over 3 micrograms per litre are considered to be high enough to raise your risk of cardiovascular disease a very high level can indicate that you've had a recent infection for example and this is something that would be anticipated to decrease over time once the infection has cleared now it is as you can see from this graph here something that tends to increase over age so you can see the mean C-reactive protein level by age and gender and you can see for both males and females it does increase with time although for some reason it seems to increase more in males but they start generally with a lower level in the earlier years moving on to another biomarker now this is a hormone it's testosterone which I think most people are familiar with and this is an anabolic hormone it's involved with muscle growth and development for example you can see with the reference range here that males have higher levels and a much broader range than females do and testosterone really is considered to be very important for the development of male social behaviour there are quite a number of studies which have linked testosterone levels and particularly changes in levels with competitive or aggressive behaviour and it's also known that as we get older testosterone does decrease and that's associated with losing muscle mass and becoming more frail as we age another protein which is a common biomarker is ferritin which is a blood cell protein so all of these so far are collected through blood samples now ferritin contains iron and what it indicates is how much iron our bodies are storing now in this case both very low levels or high levels can indicate some pathological issue so low levels for example will indicate that we have anemia which is more prevalent in women and higher levels can be associated with heart disease for example and this tends to be more prevalent in males and again at the bottom of the screen you can see the sort of levels that are used to denote whether somebody is completely absent of stored iron or depleted for example now this graph shows us the prevalence of iron depletion and iron overload by age and gender and this is data from Understand Society at waves one and two so we can see that depletion tends to be very much more an issue for females and very much more an issue during their child bearing ages with men it tends to be overload that's more problematic now I mentioned that there are biomarkers which allow us to test the function of certain organs now chronic kidney disease is a really important public health area of interest it is something that is increasingly prevalent as our population ages and there have been studies that have found that there is some social inequalities in the distribution of kidney disease as well now kidney function has in the past been assessed with a different biomarker but now it's more tended to be measured with creatinine now this is a waste product of our muscle function which is passed through the kidneys and it's secreted out in the urine so really what this allows us to do is to have a look at the levels of creatinine and indicate how well our kidneys are functioning or cleaning the blood which is one of their primary functions there are some calculations that are done and you can find these on a line and I'll mention where to find good sources of information on this later on but what's calculated is this GFR and it seems to be linked with chronic kidney disease so you can see at the bottom that for the different stages of chronic kidney disease you can see what level of this GFR is important so we can go from normal at stage 1 through to very severe kidney disease at stage 5 and here we can see by age group the prevalence of kidney disease for both men and women you can see here that this is something that really does decrease as we age and as I say in the UK certainly we have very much an ageing population hence why this is such a key area of interest so that's just some of the study biomarkers that are available there are some fantastic glossaries available online particularly one on the Understand Society website and I've got the link right at the end of the webinar for that so if you want to find out anything else about these biomarkers to get to understand them in more detail then highly recommend you go and have a look so in terms of how you can access these biomarker data we have a number of studies, social studies in the UK which do collect this information and I'm going to talk about the key ones now so the first one is a cross-sectional survey this is the Health Survey for England now if you're not familiar with it the HSE monitors the health of the English population so it says it does pretty much what it says on the Tim it's a continuous survey, it's run every year and it's been running from 1991 so there's lots of data available the sample was around 8,000 adults and 2,000 children and the survey introduced boosts from time to time just to keep the sample numbers healthy now data is collected through interview-led interviews but also nurse visits to take the blood samples for example so the biomarkers that you can find in the HSE data include fairly standard ones, health, height, weight, BMI, lung function for example there's also some ECG measurement information in there and at various points in the survey they have collected blood and urine samples and you can see I've listed here the biomarkers that you can find information on and you can see some of the ones we've discussed today are there so we've got the renal analytes for the kidney function, we've got the C-reactive protein now in terms of accessing the Health Survey for England biomarker data this is a very simple process datasets for every year are available through the UK Data Service in the usual way you can also explore some of those data through our NESTAR interface and that covers data from 1997 onwards there's also a range of really, really helpful documentation that's available so you can have a look at what the lab procedures were and how they might have changed you can have a look at the questionnaires to see exactly what people asked and you can have a look at variable lists and you can see the front cover of one of those variable lists here and we always recommend that when you're getting started with a new dataset that you have a good read through just to make sure you understand the different sampling procedures, the different interview procedures etc so the HSC is a cross-sectional survey so I'm going to move on now to look at panel and longitudinal studies we're very fortunate in the UK we have such good quality data available and we also have a number of birth cohort studies we currently hold data from three of those so that's the 1958, the 1970 and the Millennium cohorts now these cohorts have a health and medical focus but they also have a wide range of data about people's social and economic lives so they have a lot of multi-topic elements to them and these studies will sample babies born in a particular year and then it follows them throughout their lifetime so if you're interested in how people respond to early childhood experiences and what effect that might have on their adult health for example these are fantastic sources of data now the 1958 cohort has been running for the longest so they have more information available in terms of people's lifespan and biomarkers were collected from around 9,000 cohort members when they were 44, 45 years old and this includes biomarkers from blood and saliva samples blood pressure, weight, height for example lung function, hearing, all sorts of aspects of people's health and here again is the list of the biomarkers that were available so I mentioned these come from blood and saliva and you can see the list here so we've got some ones that we didn't look at earlier so we've got allergen-specific immunoglobulin for example vitamin D, some DNA information, genetic data, etc so there's a really wide range of information collected and there is some epigenetic data which collection is still underway I understand so do keep an eye on developments now in terms of accessing these data the biomarker data is available through the UK data service and there's a specific data set that holds those data and you can see there so it's study number 5594 and it's the National Child Development Study Biomedical Data there are some access conditions on that it's available for our special license agreement so do pop onto the website and just have a look at those there's a specific section which will explain what a special license access agreement looks like if you want to have a look at the genetic data for example or you want to apply to a further assay the whole blood then you will need to do that through MEDAC which hold these data I've put the link to the website on the screen and again once you've downloaded the slides you can just copy and paste that link and go straight to the website now the 1970 cohort field work is currently ongoing and we've been advised that data deposit is expected around 2018-2019 obviously once we get closer to deposit then the dates will become a little bit more firm now the collection of these biomarker data is funded by ESRC and MRC which is a medical research council and they have a number of themes that they're going to be looking at including how can we understand the health inequalities that we see within the UK now the sort of biomarkers that are being collected so we've got demographic family and social economic data but they'll be collecting blood for analytes and DNA there'll also be a lot of information about dietary health and behaviors cognition, grip strength, etc so keep your eye on developments there because that's going to be some really exciting data coming out now the Millennium Cohort Study which is the most recent one, obviously the cohort members are still very young they're just coming into early adulthood now there were some saliva samples collected for a hygiene hypothesis at age 3 and saliva samples collected for DNA extraction and genotyping at age 14 so fairly recently so the saliva samples were collected from not just the cohort members but their resident biological parents as well and this is really exciting because this is the first time in a UK study where DNA samples have been collected from both the child and two biological parents so this data is going to be really exciting in total they've got just over 23,000 samples collected so that's going to be a fantastic sample size to work with the DNA extractions are going to be genotyped the process we're advised is going to take between 1-2 years and access in due course is going to be via a special access committee such as MetaDAC that we saw earlier so again this is a survey to keep your eye on if you're interested in these sorts of data so the final study that I'm going to talk about this is another longitudinal study but rather than being a cohort study this is a household panel survey it began in 2009 and has been running every year since and this is a study which goes into selected households and it will collect information about all household members and it will carry out interviews from adults age 16 and above and also a short youth questionnaire for children aged 10 to 15 and again this is a multi-topic survey so there's a wealth of information about every aspect of people's lives here and this is also designed to follow on from the British household panel survey which ran from 1991 up until 2008 and you can actually have a look at these two surveys together because some of the original BHPS members are still being interviewed as part of the understanding society sample and really the real gem of this survey is that we can have a look at what people are experiencing throughout their lifetimes so we can see what events they experience as they happen and we can also track those individuals later on to see what sort of outcomes they experience as a result. Now data is collected through nurse assessment visits so the nurse would go to the household, they take a number of measures so this includes height, weight, body fat measurements, lung functions, grip strength, all these sort of things and they will also take blood samples. What they also do is on the day that's taken, the blood samples are taken, the nurse will go through a short questionnaire just to have a look at their health in general on the day of the measurement and they'll also ask about medications that they're taking because that can affect the levels of biomarkers so it's important to know this information so blood samples were taken un-fasted, they were processed by a laboratory and out of the sample they have just over 13,000 samples where at least one biomarker is available so again we can see a really good sample size here and here's a list of the biomarkers that you can find in these data so again we can see the things like testosterone, serotonin, hemoglobin, etc. In terms of how we access this, data from the nurse assessments has been deposited with the UK data archive and you can just access that through our website for some of the more sensitive data so if you want to have a look at very detailed individual information on dates of birth for example or you want very detailed information about geographical identifiers, if you want low level geography then there will be some additional access conditions but again you can find information about all of that on our website in terms of accessing the genetic data this isn't available through us so you will need to have a look at the understanding society website for details about how to apply for access and you can see the link here at the bottom so hopefully that's given you a flavor of what biomarker data is available to us as researchers and given you an idea of what studies and how to access them so I'm just going to finish up now by having a look at a case studies it's always really interesting to know actually what these biomarkers are being used for so what are they telling us about us as a population and I've just picked on this particular study which was done using the health survey for England data and this is using analysis of saliva samples and specifically and I'll explain what that is in just a second we will have all seen no doubt media campaigns policy campaigns aimed around this passive smoking or second hand tobacco smoke and the idea is that this second hand smoke this exposure to it affects children's lung function but subsequently in adulthood and it can increase their risk of chronic disease once they become adults as well and the reason there's a lot of concern about the impact on children is because they're thought to be at more risk and this is because they have a much more rapid respiratory rate so they take on more second hand smoke into their lungs than an adult would also their lungs their lungs etc are still developing so developing organs are seen as being at greater risk from exposure to any form of toxin and really researchers suggested that this exposure can lead to things like childhood cancers or adult cancers meningitis and cardiovascular disease later on so we can see why there's been a lot of campaigning trying to reduce this exposure particularly in children now this study used cotinin which is a biomarker which is collected from saliva samples and in the house survey for England it was collected from children aged between 4 and 15 years of age now cotinin is a metabolite of nicotine so it's used as a reliable indicator of recent exposure to either tobacco itself or its smoke and it's considered to be really the most useful biomarker for this purpose it's a very sensitive marker so very low levels can be detected it does have a half life in the body for around 16 to 20 hours so it will only really tell us about recent exposure or recent smoking so if exposure happened more than a few days ago obviously that isn't going to be picked up in terms of what level are indicative of exposure so a level of 12 nanograms per milliliter or above is indicative of actual smoking behaviour whereas levels between 0.1 nanogram to just below 12 that is taken as an indicator of second hand smoke in people who do not smoke now this report is one that was published in 2015 and you can see the link to the full report at the bottom of the screen and what they did as part of this report is to aggregate data from 2014 and 2015 from Health Survey for England just to get a really good sample size they found that 5% of children aged between 8 and 15 reported that they had ever smoked even if that was just to try a cigarette they found that smoking was actually very rare under the age of 13 but it does tend to increase from that age and they found that around 1% aged 18 to 15 smoked regularly but actually what they did find which is obviously good news from a health perspective is that the proportion of these children who are trying smoking has been decreasing over time and actually it's been decreasing to quite low levels so 4% by 2015 so some of the key findings from the report we can see here that they're looking at detectable cotoning status i.e. exposure to second hand smoke in children by age and sex and for both boys and girls those younger children were more exposed but this younger age for some reason girls seem to be more likely to be exposed than boys in terms of having a look at household income so they've analysed the exposure by equalised household income and we can see that there's a real strong association here with household income so those in the highest quintile have the very lowest levels of exposure amongst children aged 4 to 15, those in the fourth and lowest quintiles tend to have the highest so there's a really strong relationship here and again another finding perhaps not entirely surprising is that a child who lives with parents who smoke either one or two parents smoking are far more likely to be exposed to second hand smoke but even those who are regularly in contact with people who smoked in the home so that might not be a parent that might be another relative or person coming into the home were more likely to be exposed. Really the main conclusion from the report is that exposure is higher among children who live in households where one or more people smoke and actually compared to just 31% of children where no adult smoked 95% of children who live in a household where one parent smokes at home on most days were exposed again that's probably not very surprising but the good news here is that exposure to second hand smoke in general is decreasing over time and actually although this 95% seems quite alarming actually fewer than 9% of children were living at least one adult smoker so this higher exposure is confined to really a very decreasing proportion of the population and again if you want to have a look at the full report very interesting report you can see the link to the website where you can download this and there are a couple of other things that have been done so there's a study again the link is there looking at the prevalence across the UK of potential airflow obstruction and this actually uses data from HSE and from understand society and I mentioned this idea of undiagnosed conditions it's a really interesting study here which looked at the prevalence of undiagnosed diabetes using glycated hemoglobin so that's just an idea just to get you thinking about how these data can be used so I'm just finishing off very very quickly just for the next minute before we have time for any questions is to have a look at some of the resources that are available so we've talked about where you can find the data itself but there are a number of different resources which are really quite useful so for each of the studies that I've mentioned I've got a number of links here which you can access later through the slides the first one is the link to the UK data service website to the actual data series themselves so that you can have a look at the documentation and see what data sets are available so the other links are for understanding society that will take you to the particular section of their website which looks at the health and biomarker information as I mentioned earlier there's a fantastic glossary for the biomarkers there it's a really really useful read they also had a podcast around biomarker data so I'd recommend having a listen to that as well for the health survey for England there's the links there to NHS Digital and to NATSEN who managed the survey and then for the birth cohort studies the very last link is to the website for the Centre for Longitudinal Studies and they're the people responsible for those studies and again they have some fantastic documentation and information on the website so I always recommend people go into the survey websites themselves as well just to see what's there a couple of other resources that I found online which I found personally very useful, very interesting are the ESRC they have a section on biosocial research and they've got some information about what it is, what sort of projects are underway they also have a specific blog for biosocial research, fantastic blogs I sort of referenced a couple earlier, I highly recommend those very good read and then finally again that's the link to MetaDAC where you can access some of the genetic data that we've discussed. If you have any questions later on then please do as always come and ask us you can do so through our website so you can log a query with us either through the help or the getting touch links which you'll find on all of the pages wherever you are on our website and we're here to sort of help you either answer the questions or direct you to the right place to get that information and wrap up. Thank you all very much for listening I'd like to thank also colleagues from the various survey teams who were kind enough to send some information about their surveys for this webinar so I'd like to thank you to all of those involved. Thank you very much all of you for attending, hopefully you found that useful and I wish you all the very best with your research Thank you