Differences in healthy life expectancy between older migrants and non-migrants in three European countries over time

Abstract

Objectives We analysed differences in healthy life expectancy at age 50 (HLE50) between migrants and non-migrants in Belgium , the Netherlands, and England and Wales, and their trends over time between 2001 and 2011 in the latter two countries. Methods Population, mortality and health data were derived from registers, census or surveys. HLE50 and the share of remaining healthy life years were calculated for non-migrants, western and non-western migrants by sex. We applied decomposition techniques to answer whether differences in HLE50 between origin groups and changes in HLE50 over time were attributable to either differences in mortality or health. Results In all three countries, older (non-western) migrants could expect to live less years in good health than older non-migrants. Differences in HLE50 between migrants and non-migrants diminished over time in the Netherlands, but they increased in England and Wales. General health, rather than mortality, mainly explained (trends in) inequalities in healthy life expectancy between migrants and non-migrants. Conclusions Interventions aimed at reducing the health and mortality inequalities between older migrants and non-migrants should focus on prevention, and target especially non-western migrants.

Differences in the health transition patterns of migrants and non-migrants aged 50 and older in southern and western Europe (2004–2015)

“…We defined migrants, our main independent variable, as those respondents who were not born in their current country of residence. As in previous migrant health research [ 6 , 20 – 23 ], we distinguished between migrants with a western or non-western origin. We defined western migrants as those born in Europe (except Turkey), North America, Oceania or Japan [ 6 , 23 ].…”

“…These studies showed that, regardless of a generally lower socioeconomic status, migrants tend to live longer than non-migrants; this so-called ‘migrant mortality paradox’ has been observed across the life course, including at older ages [ 4 , 5 ]. However, previous research has also acknowledged that, compared to non-migrants, older migrants in Europe can expect to live a smaller number of years and a smaller share of their remaining life expectancy in good health [ 6 ]. Indeed, compared to older non-migrants, older migrants in Europe tend to have poorer self-rated health, more chronic conditions, worse functioning and higher rates of depression [ 4 , 6 – 9 ].…”

“…However, previous research has also acknowledged that, compared to non-migrants, older migrants in Europe can expect to live a smaller number of years and a smaller share of their remaining life expectancy in good health [ 6 ]. Indeed, compared to older non-migrants, older migrants in Europe tend to have poorer self-rated health, more chronic conditions, worse functioning and higher rates of depression [ 4 , 6 – 9 ]. Longitudinal studies can provide a more complete picture than cross-sectional studies of how health and health inequalities evolve over the life course of individuals, and can provide valuable information about the causes of such inequalities.…”

“…A majority of the older migrants who currently live in western Europe arrived before the early 1970s as labour migrants, or from neighbouring countries or former colonies [ 1 ]. We know that many years after migration, older migrants in Europe tend to be disadvantaged relative to non-migrants in terms of self-rated health, chronic conditions, functioning, limitations and depression [ 4 , 6 – 9 ]. This is an important difference with respect to the USA and Canada, where older migrants have been shown to have an overall health advantage relative to non-migrants at baseline [ 14 , 16 ].…”

“…In our analysis, we incorporate three dimensions of health, namely a subjective measure of overall health (self-rated health), a measure of mental health (depression) and a measure of physical health (diabetes). As in previous migrant health research [ 6 , 20 – 23 ], we also distinguish between western and non-western migrants.…”