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

Abstract

The 'healthy immigrant effect' and 'migrant mortality advantage' describe the better health and lower mortality of international immigrants as compared with the native‐born populations of high‐income countries. However, a growing body of evidence suggests that it is much more common to observe low mortality among immigrants than it is good health, pointing to the existence of a potential paradox that mirrors the well‐known gender paradox in health and mortality. To investigate this, we used the Office for National Statistics Longitudinal Study, a large‐scale representative 1% sample of the England and Wales resident population comprising linked individual‐level health, mortality, and socio‐demographic data. We compared health and mortality within and across major immigrant groups over 20 years using logistic regression for health and discrete‐time survival analysis for mortality, both before and after adjusting for socio‐demographic factors. Of the eight origin subgroups studied, we found persistent evidence of a health‐mortality paradox within three: men and women from India, Pakistan and Bangladesh, and the Caribbean. We discuss potential explanations and implications of this paradox and suggest that decision makers need to react to help these subgroups preserve their health in order to delay the onset of limiting illnesses and emergence of this paradox.

Gendering health differences between nonmigrants and migrants by duration of stay in Italy

“…The analysis confirms our expectation: overall, the health status of women is worse than that of men among both Italians and migrants for the three health measures. This finding confirms other international studies (Cooper 2002;Almeida-Filho et al 2004;Read and Gorman 2006;Song et al 2006;Gerritsen and Devillé 2009;Read and Reynolds 2012;Wallace and Darlington-Pollock 2020) and can be explained by physiological, biological, genetic, and social factors (Waldron and Johnston 1976;Benyamini, Leventhal, and Leventhal 2000;Rohlfs, Borrell, and Fonseca 2000;Idler 2003;Denton, Prus, and Walters 2004;Oksuzyan et al 2015, Oksuzyan, Gumà, andDoblhammer 2018).…”

Regional trajectories in life expectancy and lifespan variation: Persistent inequality in two Nordic welfare states

“…It is also important to note that the existence of inequality with respect to mortality will not necessarily be accompanied by inequality in other measures of health. As shown in several other studies in this special issue, there is considerable evidence of a health-mortality paradox, at least for some groups of immigrants and their descendants (Cezard, Finney, Marshall, & Kulu, 2020;Wallace & Darlington-Pollock, 2020) Future research may contribute by examining this question (e.g., building upon the evidence of selective return migration in Sweden, see Andersson & Drefahl, 2016). Our results also help to lay the foundation for future microlevel analyses, for example, by highlighting regions where improvements in life expectancy are not coupled with improvements in lifespan equality.…”

“…It is also important to note that the existence of inequality with respect to mortality will not necessarily be accompanied by inequality in other measures of health. As shown in several other studies in this special issue, there is considerable evidence of a health-mortality paradox, at least for some groups of immigrants and their descendants (Cezard, Finney, Marshall, & Kulu, 2020;Wallace & Darlington-Pollock, 2020). The limitations of our analysis include our exclusion of Åland in Finland and Gotland in Swedenboth of which may have very different trajectories as compared to mainland regions-as well as the limitations of our time series.…”

Editorial introduction: Social and spatial inequalities in health and mortality: The analysis of longitudinal register data from selected European countries

“…Two complementary papers in this special issue use census‐linked data from the United Kingdom to address the proposed ‘migrant morbidity‐mortality paradox’. In the first of these, Wallace and Darlington‐Pollock (2020) directly test the immigrant morbidity‐mortality paradox by comparing self‐reported limiting long‐term illness (LLTI) in the England and Wales census at 1991 and 2001 across immigrant groups with their survival over the subsequent 10‐ (or 20)‐year periods. The large sample from the ONS LS allows an unprecedented level of detailed analysis of these patterns, according to nine different country of birth subgroups and gender.…”