Article Text

PDF
Socioeconomic deprivation, mortality and health of within-city migrants: a population cohort study
  1. Ravi Maheswaran1,
  2. Mark Strong1,
  3. Phil Clifford2,
  4. Louise Brewins3
  1. 1Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2North of England Commissioning Support, Sheffield, UK
  3. 3Sheffield City Council, Sheffield, UK
  1. Correspondence to Professor Ravi Maheswaran, Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK; r.maheswaran{at}sheffield.ac.uk

Abstract

Background Evidence linking selective migration (the situation where people in good health move from deprived to affluent areas, whilst people in poor health move in the opposite direction) within local areas to mortality is inconclusive.

Methods Mortality in within-city migrants was examined using a Sheffield population cohort, adjusted for moves to care homes. The cohort comprised 310 894 people aged 25+ years in 2001 followed up for 9.18 years, with 42 252 (13.6%) deaths. Information on pre-existing medical conditions, socioeconomic indicators and smoking was available from a sample survey.

Results Relative risks (95% CI) of mortality in migrants from deprived to affluent areas were lower compared with people remaining in deprived areas; 0.53 (0.42 to 0.65), 0.70 (0.61 to 0.80), 0.76 (0.68 to 0.86), 0.93 (0.88 to 1.00) and 0.98 (0.93 to 1.03) in the 25–44, 45–64, 65–74, 75–84 and 85+ year age bands, respectively. They also had lower prevalence ORs (95% CI) for bronchitis (0.59 (0.39 to 0.89)), asthma (0.70 (0.53 to 0.93)), depression (0.59 (0.38 to 0.94)), and were less likely to receive benefits (0.60 (0.47 to 0.76)) and less likely to smoke (0.66 (0.51 to 0.85)).

Conversely, mortality relative risks in migrants from affluent to deprived areas were higher compared with people remaining in affluent areas; 1.71 (1.37 to 2.12), 1.59 (1.40 to 1.82), 1.44 (1.26 to 1.63), 1.18 (1.10 to 1.27) and 1.04 (1.00 to 1.09) in the corresponding age groups. They also had higher prevalence odds ratios for long-term illness (2.37 (1.71 to 3.29)), asthma (1.71 (1.25 to 2.35)), diabetes (3.03 (1.70 to 5.41)), depression (2.71 (1.74 to 4.21)), were more likely to receive benefits (2.25 (1.65 to 3.07)) and more likely to smoke (1.51 (1.12 to 2.05)).

Conclusions People moving from deprived to affluent areas had lower mortality and better health, and vice versa, especially in the younger age groups. This study provides strong evidence linking selective migration within local areas to mortality.

  • mortality
  • migration
  • inequalities

Statistics from Altmetric.com

Footnotes

  • Contributors RM designed the study in collaboration with LB and PC. PC assembled the database. RM analysed the data with input from MS and wrote the first draft. All authors contributed to the paper and approved the final draft.

  • Funding This work was supported by a grant from Sheffield Primary Care Trust.

  • Competing interests The authors report receiving a grant from Sheffield Primary Care Trust to conduct the study.

  • Ethics approval University of Sheffield Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.