Background: Ageing of ethnic minorities is leading to an ethnically diverse older population in the UK and other European countries. Ethnic inequalities in health and experiences in later life are thus emerging as an important theme within academic literature and policy debates. This paper provides a comprehensive account of the morbidity-mortality paradox in Scotland in which specific ethnic minorities report poorer health compared to the White Scottish population but at the same time live longer.

Methods: We exploit the Scottish Health and Ethnicity Linkage Study (SHELS), linking individual records of the Scottish Census 2001 to 12 years of mortality data (2001-2013). The census includes self-assessed measures of health and ethnicity. Ethnic differences in self-assessed heath (SAH) are assessed using Poisson regression. Survival analysis (Cox) is used to investigate ethnic differences in mortality and to examine whether the relationship between SAH and mortality varies by ethnic group. We stratify our analysis by sex, adjust models for age and socio-economic circumstances.

Results: Our findings shows ethnic differences in SAH in Scotland which cannot be accounted for socio-economic circumstances. The patterns of SAH by ethnicity differs to those observed in mortality by ethnicity. Our findings also demonstrate a differential subjective-objective health association in Scotland for specific ethnic groups. For example, Pakistani and Indian report poorer health outcomes for a given level of mortality compared to the White Scottish group.

Conclusion: We found ethnic differences in the relationship between self-assessed health and mortality in Scotland. Specific ethnic minorities report poorer health but exhibit lower mortality levels. This morbidity-mortality paradox is particularly strong in the South Asian population in Scotland. It requires further investigation in order to understand the phenomenon and better plan care resources for the diverse and ageing population of Scotland.