SSM - Population Health
Volume 5, 2018, Pages 48-54

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

Gartner A.* , Farewell D. , Greene G. , Trefan L. , Davies A. , Fone D. , Paranjothy S.
  • a Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
  • b Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
  • c Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
  • d Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
  • e Public Health Wales NHS Trust, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, United Kingdom
  • f Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
  • g Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom

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. © 2018 The Authors

Author Keywords

Socioeconomic gradient Selective migration inequalities Mortality

Index Keywords

urban area rural area proportional hazards model all cause mortality human health service controlled study priority journal Aged hazard ratio national health service selective migration Wales life expectancy consensus very elderly socioeconomics Article adult migration government cohort analysis mortality
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85047382992&doi=10.1016%2fj.ssmph.2018.05.004&partnerID=40&md5=f6650b48886d3acd438e3de9e5bd1517
DOI: 10.1016/j.ssmph.2018.05.004
ISSN: 23528273
Cited by: 1
Original Language: English