25 results found
Requena G, Dedman D, Quint JK, et al., 2021, The utilization and safety of umeclidinium and umeclidinium/vilanterol in UK primary care: a retrospective cohort study, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 16, Pages: 629-642, ISSN: 1176-9106
Background: Umeclidinium bromide (UMEC) and umeclidinium/vilanterol (UMEC/VI) received European approval for maintenance treatment of patients with chronic obstructive pulmonary disease (COPD) in 2014. This study examined prescribing patterns, possible off-label prescribing, potential safety-related outcomes and adherence of these medications in routine clinical practice post-approval.Methods: This retrospective, multi-database, longitudinal observational study of new users of UMEC, UMEC/VI, or other long-acting bronchodilators (LABD) analyzed data from UK electronic health record databases (primary care cohort), linked to hospital data (linked cohort). Off-label prescribing, safety outcomes (cardiovascular, respiratory, and mortality), treatment patterns, and medication adherence were assessed.Results: In the primary care cohort (new users of UMEC n=3875; UMEC/VI n=2224; other LABD n=32,809), two-thirds of UMEC users were prescribed concomitant inhaled corticosteroids/long-acting β2-agonists. Possible off-label prescribing, defined as use in patients without COPD, was similar for UMEC (7.0%) and UMEC/VI (8.8%), but higher for new users of other LABD (18.0%). There were 547 UMEC users and 512 UMEC/VI users in the linked cohort. In both cohorts, incidence rates (IRs) of cardiovascular outcomes were similar for UMEC and UMEC/VI users (myocardial infarction IR per 1000 person-years [95% CIs]: UMEC 6.9 [4.4, 10.2]; UMEC/VI 6.8 [3.5, 11.9]). IRs of pneumonia and acute COPD exacerbations (AECOPD) were slightly higher among UMEC users compared with UMEC/VI users (AECOPD IR per 1000 person-years [95% CIs]: UMEC 979 [931, 1030]; UMEC/VI 746 [687, 811]). Adherence (medication possession ratio ≥ 80%) was 64% for UMEC and UMEC/VI.Conclusion: Most new users of UMEC were receiving multiple-inhaler triple therapy. Off-label prescribing was uncommon for new users of UMEC and UMEC/VI. Incidence of cardiovascular and respiratory outcomes was as expected for these drug classes
Parkes B, Hansell AL, Ghosh RE, et al., 2020, Risk of congenital anomalies near municipal waste incinerators in England and Scotland, Retrospective population-based cohort study, Vol: 134, ISSN: 0160-4120
Background: Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. Objectives: To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. Methods: Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations. Results: Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98–1·02) for all congenital anomalies; 0·99 (0·97–1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00–1·04) for all congenital anomalies combined; 1·02 (1·00–1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01–1·08) for congenital heart defect sand 1·07 (1·02–1·12) for genital anomalies. Discussion: We found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.
Freni Sterrantino A, Afoakwah P, Smith RB, et al., 2019, Birth weight centiles and small for gestational age by sex and ethnicity for England and Wales, Archives of Disease in Childhood, Vol: 104, Pages: 1188-1192, ISSN: 1468-2044
Objectives To construct UK Ethnic Birth Weight Centiles (UK-EBWC) for gestational age and cut-offs for small for gestational age (SGA) for England and Wales and to evaluate the SGA misclassification using the UK centiles.Design Analysis of national birth data.Participants All live singleton births in England and Wales in 2006 to 2012, as recorded by the Office for National Statistics (ONS) and birth registrations, linked with National Health Service (NHS) into Numbers for Babies (NN4B).Main Outcome Measures Both sex-specific and ethnicity-sex-specific birth weight centiles for gestational age, and ethnicity-sex-specific SGA cut-offs. Centiles were computed using the Generalized Additive Model for Location, Scale and Shape (GAMLSS). Results Our sex-specific centiles performed well and showed an agreement between the expected and observed number of births below the centiles. The ethnicity-sex-specific centiles for Black and Asian presented lower values compared to the White centiles. Comparisons of sex-specific and ethnicity-sex-specific centiles shows that use of sex-specific centiles increases the SGA diagnosed cases by 50% for Asian, 30% for South Asian (Indian, Pakistani and Bangladeshi) and 20% for Black ethnicity.Conclusions The centiles show important differences between ethnic groups, in particular the 10th centile used to define SGA. To account for these differences and to minimize misclassification of SGA, we recommend the use of customized birth weight centiles.
Freni Sterrantino A, Elliott P, Blangiardo M, et al., 2019, Bayesian spatial modelling for quasi-experimental designs: an interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio, Environment International, Vol: 128, Pages: 109-115, ISSN: 0160-4120
BackgroundThere is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level.MethodsWe specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996–2012. We included comparative areas matched one-to-one of similar size and area characteristics.ResultsDuring the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with −8 deaths per 100,000 infants (95% CI −62, 40) and with a difference in sex ratio of −0.004 (95% CI −0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas.ConclusionOur method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.
Ghosh RE, Crellin E, Beatty S, et al., 2019, How Clinical Practice Research Datalink data are used to support pharmacovigilance, THERAPEUTIC ADVANCES IN DRUG SAFETY, Vol: 10, Pages: 1-7, ISSN: 2042-0986
Padmanabhan S, Carty L, Cameron E, et al., 2019, Approach to record linkage of primary care data from Clinical Practice Research Datalink to other health-related patient data: overview and implications, European Journal of Epidemiology, Vol: 34, Pages: 91-99, ISSN: 0393-2990
Record linkage is increasingly used to expand the information available for public health research. An understanding of record linkage methods and the relevant strengths and limitations is important for robust analysis and interpretation of linked data. Here, we describe the approach used by Clinical Practice Research Datalink (CPRD) to link primary care data to other patient level datasets, and the potential implications of this approach for CPRD data analysis. General practice electronic health record software providers separately submit de-identified data to CPRD and patient identifiers to NHS Digital, excluding patients who have opted-out from contributing data. Data custodians for external datasets also send patient identifiers to NHS Digital. NHS Digital uses identifiers to link the datasets using an 8-stage deterministic methodology. CPRD subsequently receives a de-identified linked cohort file and provides researchers with anonymised linked data and metadata detailing the linkage process. This methodology has been used to generate routine primary care linked datasets, including data from Hospital Episode Statistics, Office for National Statistics and National Cancer Registration and Analysis Service. 10.6 million (M) patients from 411 English general practices were included in record linkage in June 2018. 9.1M (86%) patients were of research quality, of which 8.0M (88%) had a valid NHS number and were eligible for linkage in the CPRD standard linked dataset release. Linking CPRD data to other sources improves the range and validity of research studies. This manuscript, together with metadata generated on match strength and linkage eligibility, can be used to inform study design and explore potential linkage-related selection and misclassification biases.
Ghosh RE, Freni-Sterrantino A, Douglas P, et al., 2019, Fetal growth, stillbirth, infant mortality and other birth outcomes near UK municipal waste incinerators; retrospective population based cohort and case-control study, Environment International, Vol: 122, Pages: 151-158, ISSN: 0160-4120
Background: Some studies have reported associations between municipal waste incinerator (MWI) exposures and adverse birth outcomes but there are few studies of modern MWIs operating to current European Union (EU) Industrial Emissions Directive standards. Methods: Associations between modelled ground-level particulate matter ≤10 μm in diameter (PM10) from MWI emissions (as a proxy for MWI emissions) within 10 km of each MWI, and selected birth and infant mortality outcomes were examined for all 22 MWIs operating in Great Britain 2003–10. We also investigated associations with proximity of residence to a MWI. Outcomes used were term birth weight, small for gestational age (SGA) at term, stillbirth, neonatal, post-neonatal and infant mortality, multiple births, sex ratio and preterm delivery sourced from national registration data from the Office for National Statistics. Analyses were adjusted for relevant confounders including year of birth, sex, season of birth, maternal age, deprivation, ethnicity and area characteristics and random effect terms were included in the models to allow for differences in baseline rates between areas and in incinerator feedstock. Results: Analyses included 1,025,064 births and 18,694 infant deaths. There was no excess risk in relation to any of the outcomes investigated during pregnancy or early life of either mean modelled MWI PM10 or proximity to an MWI. Conclusions: We found no evidence that exposure to PM10 from, or living near to, an MWI operating to current EU standards was associated with harm for any of the outcomes investigated. Results should be generalisable to other MWIs operating to similar standards.
Smith RB, Fecht D, Gulliver J, et al., 2017, Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study, BMJ, Vol: 359, ISSN: 1756-1833
Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.Design Retrospective population based cohort study.Setting Greater London and surrounding counties up to the M25 motorway (2317 km2), UK, from 2006 to 2010.Participants 540 365 singleton term live births.Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.Results Average air pollutant exposures across pregnancy were 41 μg/m3 nitrogen dioxide (NO2), 73 μg/m3 nitrogen oxides (NOx), 14 μg/m3 particulate matter with aerodynamic diameter <2.5 μm (PM2.5), 23 μg/m3 particulate matter with aerodynamic diameter <10 μm (PM10), and 32 μg/m3 ozone (O3). Average daytime (LAeq,16hr) and night-time (Lnight) road traffic A-weighted noise levels were 58 dB and 53 dB respectively. Interquartile range increases in NO2, NOx, PM2.5, PM10, and source specific PM2.5 from traffic exhaust (PM2.5 traffic exhaust) and traffic non-exhaust (brake or tyre wear and resuspension) (PM2.5 traffic non-exhaust) were associated with 2% to 6% increased odds of term LBW, and 1% to 3% increased odds of term SGA. Air pollutant associations were robust to adjustment for road traffic noise. Trends of decreasing birth weight across increasing road traffic noise categories were observed, but were strongly attenuated when adjusted for primary traffic related air pollutants. Only PM2.5 traffic exhaust and PM2.5 were consistently associated with increased risk of term LBW after adjustment for each of the other air pollutants. It was estimated that 3% of term LBW cases in London are directly attributable to residential exposure to PM2.5>13.8 μg/m3during pregnancy.Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on b
Ghosh R, Dag Berild J, Freni Sterrantino A, et al., 2017, Birth weight trends in England and Wales (1986– 2012): babies are getting heavier, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 103, Pages: F264-F270, ISSN: 1468-2052
Introduction Birth weight is a strong predictor of infant mortality, morbidity and later disease risk. Previous work from the 1980s indicated a shift in the UK towards heavier births; this descriptive analysis looks at more recent trends.Methods Office for National Statistics (ONS) registration data on 17.2 million live, single births from 1986 to 2012 were investigated for temporal trends in mean birth weight, potential years of birth weight change and changes in the proportions of very low (<1500 g), low (<2500 g) and high (≥4000 g) birth weight. Analysis used multiple linear and logistic regression adjusted for maternal age, marital status, area-level deprivation and ethnicity. Additional analyses used the ONS NHS Numbers for Babies data set for 2006–2012, which has information on individual ethnicity and gestational age.Results Over 27 years there was an increase in birth weight of 43 g (95% CI 42 to 44) in females and 44 g (95% CI 43 to 45) in males, driven by birth weight increases between 1986–1990 and 2007–2012. There was a concurrent decreased risk of having low birth weight but an 8% increased risk in males and 10% increased risk in females of having high birth weight. For 2006–2012 the birth weight increase was greater in preterm as compared with term births.Conclusions Since 1986 the birth weight distribution of live, single births in England and Wales has shifted towards heavier births, partly explained by increases in maternal age and non-white ethnicity, as well as changes in deprivation levels. Other potential influences include increases in maternal obesity and reductions in smoking prevalence particularly following the introduction of legislation restricting smoking in public places in 2007.
Douglas P, Freni-Sterrantino A, Leal Sanchez M, et al., 2017, Estimating Particulate Exposure from Modern Municipal Waste Incinerators in Great Britain, Environmental science & technology, Vol: 51, Pages: 7511-7519, ISSN: 0013-936X
Municipal Waste Incineration (MWI) is regulated through the European Union Directive on Industrial Emissions (IED), but there is ongoing public concern regarding potential hazards to health. Using dispersion modeling, we estimated spatial variability in PM10 concentrations arising from MWIs at postcodes (average 12 households) within 10 km of MWIs in Great Britain (GB) in 2003-2010. We also investigated change points in PM10 emissions in relation to introduction of EU Waste Incineration Directive (EU-WID) (subsequently transposed into IED) and correlations of PM10 with SO2, NOx, heavy metals, polychlorinated dibenzo-p-dioxins/furan (PCDD/F), polycyclic aromatic hydrocarbon (PAH) and polychlorinated biphenyl (PCB) emissions. Yearly average modeled PM10 concentrations were 1.00 × 10-5 to 5.53 × 10-2 μg m-3, a small contribution to ambient background levels which were typically 6.59-2.68 × 101 μg m-3, 3-5 orders of magnitude higher. While low, concentration surfaces are likely to represent a spatial proxy of other relevant pollutants. There were statistically significant correlations between PM10 and heavy metal compounds (other heavy metals (r = 0.43, p = <0.001)), PAHs (r = 0.20, p = 0.050), and PCBs (r = 0.19, p = 0.022). No clear change points were detected following EU-WID implementation, possibly as incinerators were operating to EU-WID standards before the implementation date. Results will be used in an epidemiological analysis examining potential associations between MWIs and health outcomes.
Hansell A, Ghosh RE, Blangiardo M, et al., 2016, Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study, Thorax, Vol: 71, Pages: 330-338, ISSN: 1468-3296
Introduction Long-term air pollution exposure contributes to mortality but there are few studies examining effects of very long-term (>25 years) exposures.Methods This study investigated modelled air pollution concentrations at residence for 1971, 1981, 1991 (black smoke (BS) and SO2) and 2001 (PM10) in relation to mortality up to 2009 in 367 658 members of the longitudinal survey, a 1% sample of the English Census. Outcomes were all-cause (excluding accidents), cardiovascular (CV) and respiratory mortality.Results BS and SO2 exposures remained associated with mortality decades after exposure—BS exposure in 1971 was significantly associated with all-cause (OR 1.02 (95% CI 1.01 to 1.04)) and respiratory (OR 1.05 (95% CI 1.01 to 1.09)) mortality in 2002–2009 (ORs expressed per 10 μg/m3). Largest effect sizes were seen for more recent exposures and for respiratory disease. PM10 exposure in 2001 was associated with all outcomes in 2002–2009 with stronger associations for respiratory (OR 1.22 (95% CI 1.04 to 1.44)) than CV mortality (OR 1.12 (95% CI 1.01 to 1.25)). Adjusting PM10 for past BS and SO2 exposures in 1971, 1981 and 1991 reduced the all-cause OR to 1.16 (95% CI 1.07 to 1.26) while CV and respiratory associations lost significance, suggesting confounding by past air pollution exposure, but there was no evidence for effect modification. Limitations include limited information on confounding by smoking and exposure misclassification of historic exposures.Conclusions This large national study suggests that air pollution exposure has long-term effects on mortality that persist decades after exposure, and that historic air pollution exposures influence current estimates of associations between air pollution and mortality.
Ghosh RE, Ashworth DC, Hansell AL, et al., 2016, Routinely collected English birth data sets: comparisons and recommendations for reproductive epidemiology., Archives of Disease in Childhood: Fetal and Neonatal edition, Vol: 101, Pages: F451-F457, ISSN: 1359-2998
BACKGROUND: In England there are four national routinely collected data sets on births: Office for National Statistics (ONS) births based on birth registrations; Hospital Episode Statistics (HES) deliveries (mothers' information); HES births (babies' information); and NHS Numbers for Babies (NN4B) based on ONS births plus gestational age and ethnicity information. This study describes and compares these data, with the aim of recommending the most appropriate data set(s) for use in epidemiological research and surveillance. METHODS: We assessed the completeness and quality of the data sets in relation to use in epidemiological research and surveillance and produced detailed descriptive statistics on common reproductive outcomes for each data set including temporal and spatial trends. RESULTS: ONS births is a high quality complete data set but lacks interpretive and clinical information. HES deliveries showed good agreement with ONS births but HES births showed larger amounts of missing or unavailable data. Both HES data sets had improved quality from 2003 onwards, but showed some local spatial variability. NN4B showed excellent agreement with ONS and HES deliveries for the years available (2006-2010). Annual number of births increased by 17.6% comparing 2002 with 2010 (ONS births). Approximately 6% of births were of low birth weight (2.6% term low birth weight) and 0.5% were stillbirths. CONCLUSIONS: Routinely collected data on births provide a valuable resource for researchers. ONS and NN4B offer the most complete and accurate record of births. Where more detailed clinical information is required, HES deliveries offers a high quality data set that captures the majority of English births.
Halonen JI, Blangiardo M, Toledano MB, et al., 2016, Is long-term exposure to traffic pollution associated with mortality? A small-area study in London, Environmental Pollution, Vol: 208, Pages: 25-32, ISSN: 0269-7491
Ghosh RE, Close R, McCann LJ, et al., 2015, Analysis of hospital admissions due to accidental non-fire-related carbon monoxide poisoning in England, between 2001 and 2010, Journal of Public Health, Vol: 38, Pages: 76-83, ISSN: 1741-3850
Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England.Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO and X47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26).Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colder winter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years.Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions.
Smit LAM, Strachan DP, Vermeulen R, et al., 2014, Human leukocyte antigen class II variants and adult-onset asthma: does occupational allergen exposure play a role?, EUROPEAN RESPIRATORY JOURNAL, Vol: 44, Pages: 1234-1242, ISSN: 0903-1936
Hansell AL, Beale HRFLA, Beale LA, et al., 2014, The Environment and Health Atlas for England and Wales, Publisher: Oxford University Press, ISBN: 9780198706946
The Environment and Health Atlas for England and Wales is an authoritative collection of over 80 full color maps showing geographic patterns of common environmental exposures and diseases of public health importance, along with interpretive ...
Hansell A, Ghosh RE, Poole S, et al., 2014, Occupational Risk Factors for Chronic Respiratory Disease in a New Zealand Population Using Lifetime Occupational History, JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 56, Pages: 270-280, ISSN: 1076-2752
Hansell AL, Blangiardo M, Fortunato L, et al., 2014, Daytime and night-time aircraft noise and cardiovascular disease near Heathrow airport in London
Background. Few studies have investigated associations of aircraft noise with cardiovascular health. We investigated this in areas exposed to noise from London Heathrow airport. Methods. A small area study was conducted in 12,110 census output areas covering 3.6 million residents. Risks for hospital admissions and mortality in 2001-05 were assessed in relation to aircraft noise in 2001, adjusted for relevant confounders. Night (Lnight) and daytime (LAeq,16h) aircraft noise were assessed separately. Results. Higher aircraft noise was associated with higher relative risks for hospital admissions and mortality from stroke, coronary heart disease (CHD) and cardiovascular disease. Risk estimates were higher for night-time than daytime noise. Adjusted risks werehighest for stroke, with RR 1.29 [95% CI 1.14 to 1.46] for Lnight and RR 1.08 [95% CI 1.02 to 1.14] for LAeq,16hfor >55dB vs. <50dB. All linear dose-response relationships were statistically significant for hospital admissions but not for mortality, except for CHD and LAeq,16h. Discussion. This research attracted a high level of policy interest. However, the impact of this and other recent papers on policy decisions such as increased airport capacity in England is currently unclear. Priority areas for follow-up health research into aircraft noise need to be considered.
Hansell AL, Ghosh RE, Elliott P, 2013, AIRCRAFT NOISE AND HEALTH Whether noise exposure causes stroke or hypertension is still not known Reply, BMJ-BRITISH MEDICAL JOURNAL, Vol: 347, ISSN: 1756-1833
Hansell AL, Blangiardo M, Fortunato L, et al., 2013, Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study., BMJ, Vol: 347, ISSN: 0959-535X
To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population.
Butland BK, Ghosh R, Strachan DP, et al., 2011, Job choice and the influence of prior asthma and hay fever, OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 68, Pages: 494-501, ISSN: 1351-0711
Ghosh R, Cullinan P, Strachan D, et al., 2010, JOB CATEGORIES AND RISK OF ADULT ONSET ASTHMA IN THE 1958 BIRTH COHORT FROM AGE 16 TO AGE 42 YEARS, British-Thoracic-Society-Winter-Meeting 2010, Publisher: B M J PUBLISHING GROUP, Pages: A73-A73, ISSN: 0040-6376
Ghosh R, Jarvis D, Strachan D, et al., 2010, EMPLOYMENT HISTORIES OF PEOPLE WITH ASTHMA IN THE 1958 BIRTH COHORT, British-Thoracic-Society-Winter-Meeting 2010, Publisher: B M J PUBLISHING GROUP, Pages: A51-A51, ISSN: 0040-6376
Ghosh R, Cullinan P, Strachan D, et al., 2009, EXPOSURE TO OCCUPATIONAL AGENTS AND RISK OF ASTHMA IN THE 1958 BIRTH COHORT FROM AGE 16 TO AGE 33 YEARS, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A73-A74, ISSN: 0040-6376
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