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Do cardiometabolic, behavioural and socioeconomic factors explain the ‘healthy migrant effect’ in the UK? Linked mortality follow-up of South Asians compared with white Europeans in the Newcastle Heart Project
  1. Louise Hayes1,
  2. Martin White1,2,
  3. Richard J Q McNally1,
  4. Nigel Unwin1,2,3,
  5. Anh Tran1,
  6. Raj Bhopal4
  1. 1Health and Society, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
  2. 2MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  3. 3Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
  4. 4Edinburgh Migration, Ethnicity and Health Research Group, Centre for Population Health Sciences, Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Louise Hayes, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK; louise.hayes{at}


Background Immigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK.

Methods A linked 17–21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709) men and women, aged 25–74 years, recruited between 1993 and 1997. Poisson regression was used to estimate mortality rate ratios (MRRs) for all-cause mortality. Sensitivity analysis explored the possible effect of differences between ethnic groups in loss to follow-up. The impact of adjustment for established risk factors on MRRs was studied.

Results South Asians had lower all-cause age-adjusted and sex-adjusted mortality than Europeans (MRR 0.70; 95% CI 0.58 to 0.85). There was higher loss to follow-up in South Asians. Sensitivity analyses demonstrated that this did not account for the observed lower mortality. Adjustment for cardiometabolic, behavioural and socioeconomic characteristics attenuated but did not eliminate the mortality differences between South Asians and Europeans, although CIs now cross 1 (MRR 0.79; 95% CI 0.55 to 1.13).

Conclusions South Asians had lower all-cause mortality compared with European origin individuals living in Newcastle upon Tyne that were not accounted for by incomplete mortality data. It is possible that such migrants to the UK have the resources and motivation to move in search of better opportunities and may be healthier and wealthier than those who remain in their country of origin. These findings challenge us to better understand and measure the factors contributing to their survival advantage.

  • Migration
  • Mortality
  • Health Inequalities

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  • Contributors LH contributed to the planning, conduct and interpretation of data analyses and was the lead writer. RB, MW and NU contributed to the study hypotheses and design, supervision, screening, planning and interpretation of data. RJQM contributed to the planning and interpretation of data analyses. AT contributed to data management and planning of analyses. All authors read and agreed the final manuscript.

  • Funding This work was supported by Barclay Trust, British Diabetic Association (now Diabetes UK), British Heart Foundation, Department of Health, Development Directorate of the Northern Regional Health Authority, Newcastle Health Authority.

  • Competing interests None declared.

  • Ethics approval Newcastle upon Tyne Joint Ethics Committee.

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