Evidencing the gap between health expectancy and life expectancy for ethnic groups in Scotland.

Abstract

<jats:p>Background&#x0D; Recent evidence has shown that ethnic minorities live longer than the majority population in Scotland. This mortality advantage in ethnic minorities is not unique to Scotland. However, whether morbidity patterns by ethnicity align with mortality patterns by ethnicity is unknown. Thus, this study explores ethnic differences in health expectancies (HE) in Scotland and contrasts HE with life expectancy (LE) findings.&#x0D; Methods&#x0D; The Scottish Health and Ethnicity Linkage study anonymously links the Scottish Census 2001 for 4.6 million people to mortality records. The Scottish Census 2001 collected two measures of self-assessed health, self-declared ethnicity, age, and sex. Utilising the life tables used to calculate life expectancy by ethnicity and sex in Scotland, the Sullivan method was employed to calculate two measures of health expectancy (healthy life expectancy and disability-free life expectancy) by ethnicity and sex. 95% confidence intervals were calculated to detect significant differences compared to the majority White Scottish population, taken as reference.&#x0D; Results&#x0D; Longer health expectancies were found in males and females of Other White British, Other White, and Chinese origins as well as in Indian males compared to White Scottish populations. Any Mixed Background and Pakistani populations had the shortest healthy life expectancies. Patterns of health expectancy by ethnicity mostly aligned with patterns of life expectancy by ethnicity with the clear exception of the Pakistani population who showed among the longest life expectancies with the shortest health expectancies. Contrasting HE with LE findings, the number of years in an unhealthy state was greater in females than in males for each ethnic group. In relation to ethnicity, Pakistani and Indian populations had the highest number of years in an unhealthy state in Scotland. Pakistani females showed the strong-est disadvantage in this respect.&#x0D; Conclusion&#x0D; Pakistani populations had the shortest health expectancies contrasting with the longest life expectancies in Scotland. Future research should aim to understand why such a discrepancy occurs while policy makers ensure that fair and adapt-ed care is provided to offer better quality of life for the most vulnerable.</jats:p>

Poor health, low mortality? Paradox found among immigrants in England and Wales

“…This disparity, evocative of the ‘gender paradox’—in which women have worse health but live longer than men (Case & Paxson, 2005; Nathanson, 1975; Van Oyen et al, 2013)—has received little attention. Indeed, it has only been studied a handful of times before, largely in Australia (Kouris‐Blazos, 2002; Kouris‐Blazos & Itsiopoulos, 2014; Stanaway et al, 2020) and occasionally in Europe (Carnein, Milewski, Doblhammer, & Nusselder, 2014; Cezard, 2020; Cezard, Finney, Marshall, & Kulu, 2020; Reus‐Pons, Kibele, & Janssen, 2017).…”

“…Of these previous studies, just one has investigated the paradox at the micro‐level using linked health and death data (Stanaway et al, 2020). Others have instead compared macro‐level measures of overall and healthy or disability free life expectancies (Carnein et al, 2014; Cezard, 2020; Reus‐Pons et al, 2017) or reviewed previous evidence (Kouris‐Blazos, 2002; Kouris‐Blazos & Itsiopoulos, 2014). Additionally, nearly all of the studies have focused on one origin group (Carnein et al, 2014; Cezard et al, 2020; Kouris‐Blazos, 2002; Kouris‐Blazos & Itsiopoulos, 2014; Stanaway et al, 2020).…”

“…In Europe, several studies from Germany (Carnein et al, 2014), Scotland (Cezard, 2020), and a multi country study of the Netherlands, Belgium, and England and Wales (Reus‐Pons et al, 2017) have compared total and healthy life expectancy among several immigrant groups with their native‐born counterparts. Calculating expected years of life for Germans and Turkish immigrants between ages 50 and 79, Carnein et al (2014) found that Turkish men and women had higher life expectancies, combined with a greater number of years spent living with health limitations.…”

“…Then, in an micro‐level regression of health limitations only, they found age, marital status, education level, duration of stay, language fluency, satisfaction with living conditions, and subjective well‐being to be salient predictors of health limitations (Carnein et al, 2014). A study from Scotland contrasted healthy and disability‐free life expectancy with life expectancy at aged 65 for the major ethnic minority groups (Cezard, 2020). The author found that individuals in the Indian and Pakistani ethnic groups, especially women, had higher life expectancy at age 65 than White Scots, but lower proportions of life spent in good health or without disability.…”

“…These three studies, although important in uncovering an initial health mortality paradox among immigrants in European countries, did not consider the role of socio‐demographic factors in health and mortality differences between foreign‐ and native‐born and how this might affect the observation of the paradox. Furthermore, the observation of the paradox among certain ethnic minority groups in Scotland (Cezard, 2020) needs to be interpreted somewhat differently given that ethnicity combines immigrants with their descendants. We know from previous research that descendants do not benefit from the same low mortality as immigrants; they often have higher mortality than the ancestral native‐born do (Guillot, Khlat, & Wallace, 2019; Manhica, Toivanen, Hjern, & Rostila, 2015; Tarnutzer et al, 2012; Wallace, 2016), so it is conceivable that their health might differ too.…”