Morbidity-Mortality Paradox Among South Asians Living in Britain

Frances Darlington-Pollock, University of Liverpool
Matthew Wallace, Ined

Background: immigrants from India, Pakistan, and Bangladesh are three of the largest and most important foreign-born populations in Britain. The morbidity-mortality literature on South Asians is fascinating because they report higher limiting long-term illness (LLTI) rates yet lower mortality than the UK-born. Such an inconsistency may be down to study design i.e. differing definitions, time periods, and age-ranges. However, given that LLTI has been proven to be an effective proxy for mortality, such an inconsistency remains striking. Aim: we would like to know whether the paradox is real: are South Asians living longer, but in worse health, than the UK-born (which would impact demand for health services and require culture-specific health policies) or whether it is generated by overestimation of LLTI, or underestimation of mortality. Our initial aim is to calculate LLTI and mortality ratios for Indians, Pakistanis and Bangladeshis, using a consistent definition (country of birth), age group (20-85+) and period (2010-2012) to determine whether we can observe this morbidity-mortality paradox among South Asians. Data and methods: we calculate age-adjusted and age-specific LLTI and mortality incidence rate ratios through Poisson regression by sex, using the age range 20-24 up to 85+. Death and population counts are taken from the 2011 Census and Office for National Statistics Mortality tables; LLTI and population counts are taken from a 5% sample of the 2011 Census. Results: we observe this morbidity-mortality paradox in all groups except Indian males. The paradox begins emerges around age 40. Future work: our next step is to use an individual-level, longitudinal dataset which allows us to track South Asians and UK-born by their linked LLTI-mortality status. In doing this we will be able to investigate differences in mortality (rates, time-to-death, and cause of death) among South Asians relative to the England and Wales-born according to their LLTI status.

Presented in Session 18: Health, Morbidity, and Mortality Among International Migrants