Does selective migration alter socioeconomic inequalities in mortality in Wales?: a record-linked total population e-cohort study

Andrea Gartner; Daniel Farewell; Giles Greene; Laszlo Trefan; Alisha Davies; David Fone; Shantini Paranjothy

doi:10.1016/j.ssmph.2018.05.004

Does selective migration alter socioeconomic inequalities in mortality in Wales? a record-linked total population e-cohort study

Andrea Gartner^* (Corresponding Author), Daniel Farewell, Giles Greene, Laszlo Trefan, Alisha Davies, David Fone, Shantini Paranjothy

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

Original language	English
Pages (from-to)	48-54
Number of pages	7
Journal	SSM - Population Health
Volume	5
Early online date	24 May 2018
DOIs	https://doi.org/10.1016/j.ssmph.2018.05.004
Publication status	Published - Aug 2018

Bibliographical note

Funding for this work was received from Public Health Wales NHS Trust as part of a report on migration and health. Support for the report was also received from the National Centre for Population Health and Wellbeing Research (NCPHWR). Andrea Gartner is funded through the NCPHWR and David Fone, Shantini Paranjothy and Daniel Farewell are members of the NCPHWR team in Cardiff University, School of Medicine. Neither funder bears any responsibility for the analysis or interpretation of the data presented here. We used data from the CHALICE project, which was originally funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 09/3007/02). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health. We would like to thank Jenny Morgan for her work on data cleaning and validation of the original dataset.

Keywords

inequalities
selective migration
mortality
socioeconomic gradient

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Does selective migration alter socioeconomic inequalities in mortality in Wales?: a record-linked total population e-cohort study",

abstract = "Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.",

keywords = "inequalities, selective migration, mortality, socioeconomic gradient",

author = "Andrea Gartner and Daniel Farewell and Giles Greene and Laszlo Trefan and Alisha Davies and David Fone and Shantini Paranjothy",

note = "Funding for this work was received from Public Health Wales NHS Trust as part of a report on migration and health. Support for the report was also received from the National Centre for Population Health and Wellbeing Research (NCPHWR). Andrea Gartner is funded through the NCPHWR and David Fone, Shantini Paranjothy and Daniel Farewell are members of the NCPHWR team in Cardiff University, School of Medicine. Neither funder bears any responsibility for the analysis or interpretation of the data presented here. We used data from the CHALICE project, which was originally funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 09/3007/02). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health. We would like to thank Jenny Morgan for her work on data cleaning and validation of the original dataset. ",

year = "2018",

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doi = "10.1016/j.ssmph.2018.05.004",

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T1 - Does selective migration alter socioeconomic inequalities in mortality in Wales?

T2 - a record-linked total population e-cohort study

AU - Gartner, Andrea

AU - Farewell, Daniel

AU - Greene, Giles

AU - Trefan, Laszlo

AU - Davies, Alisha

AU - Fone, David

AU - Paranjothy, Shantini

N1 - Funding for this work was received from Public Health Wales NHS Trust as part of a report on migration and health. Support for the report was also received from the National Centre for Population Health and Wellbeing Research (NCPHWR). Andrea Gartner is funded through the NCPHWR and David Fone, Shantini Paranjothy and Daniel Farewell are members of the NCPHWR team in Cardiff University, School of Medicine. Neither funder bears any responsibility for the analysis or interpretation of the data presented here. We used data from the CHALICE project, which was originally funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 09/3007/02). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health. We would like to thank Jenny Morgan for her work on data cleaning and validation of the original dataset.

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N2 - Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

AB - Recent studies found evidence of health selective migration whereby healthy people move to less deprived areas and less healthy people move to or stay in more deprived areas. There is no consensus, however, on whether this influences health inequalities. Measures of socio-economic inequalities in mortality and life expectancy are widely used by government and health services to track changes over time but do not consider the effect of migration. This study aims to investigate whether and to what extent migration altered the observed socioeconomic gradient in mortality. Data for the population of Wales (3,136,881) registered with the National Health Service on 01/01/2006 and follow-up for 24 quarters were individually record-linked to ONS mortality files. This included moves between lower super output areas (LSOAs), deprivation quintiles and rural-urban class at each quarter, age, sex, and date of death. Cox regression models were used to estimate the hazard ratios for the deprivation quintiles in all-cause mortality, as well as deprivation change between the start and end of the study. We found evidence of health selective migration in some groups, for example people aged under 75 leaving the most deprived areas having a higher mortality risk than those they left behind, suggesting widening inequalities, but also found the opposite pattern for other migration groups. For all ages, those who lived in the most deprived quintile had a 57% higher risk of death than those in the least deprived quintile, allowing deprivation to vary with moves over time. There was little change in this risk when people were artificially kept in their deprivation quintile of origin (54% higher). Overall, migration during the six year window did not substantially alter the deprivation gradient in mortality in Wales between 2006 and 2011.

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KW - selective migration

KW - mortality

KW - socioeconomic gradient

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DO - 10.1016/j.ssmph.2018.05.004

M3 - Article

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