As populations age and migration grows, the health of immigrants increasingly shapes future healthcare and social needs. Prior research often reports lower mortality among migrants compared with non-migrants—a pattern termed the Healthy Immigrant Effect (HIE)—but evidence on morbidity and functional health is mixed. Health advantages observed on arrival may erode within a few years, and systematic reviews have reported higher rates of some chronic conditions and worse self-rated health among migrants. These inconsistencies underscore the need to examine both mortality and health simultaneously rather than relying on single-outcome measures. The authors use combined measures of quantity and quality of life—life expectancy (LE) and disability-free life expectancy (DFLE)—to provide a more nuanced picture of immigrant health in England and Wales at the lowest-level country-of-birth detail available.
This study adopts a total-population, repeated cross-sectional approach using ONS data for three time windows centered on censuses: 2000–02, 2010–12 and 2020–22. Mortality counts were obtained from ONS vital registration tables aggregated over three-year periods around each census to increase observed deaths and statistical power. Prevalence of limiting long-term illness (LLTI) and population denominators were taken from custom ONS census tables for 2001, 2011 and 2021, disaggregated by age (detailed age groups including 90+), sex, and country of birth (36 lowest-level countries and aggregated regions; final analytic set included 37 countries of birth).
Prior to release, the ONS applied standard data editing, imputation, and coverage adjustment procedures (including the Census Coverage Survey, dual system estimation and a final statistical coverage adjustment). The study used these prepared bespoke tables for LLTI prevalence and population counts, and ONS-provided death counts by country of birth, age and sex.
Life tables were constructed from whole-population mortality data to estimate LE at age 50 for each country-of-birth group and sex. The Sullivan method was used to estimate DFLE at age 50 by combining the life table person-years with LLTI prevalence from the corresponding census. Comparisons were made against the England & Wales-born population at each time point to identify differences in both mortality and disability and to assess changes over time.
The analyses reveal considerable heterogeneity across migrant groups with respect to both LE and DFLE at age 50. Most migrant populations consistently exhibited a Healthy Immigrant Effect, with both higher LE and higher DFLE than the England & Wales-born population across all three time points.
However, the aggregated picture masks important exceptions. Several relatively large migrant groups displayed an unhealthy migrant effect, characterised by lower LE and lower DFLE relative to the England & Wales-born population. The authors highlight people born in Scotland and the Republic of Ireland as examples of such groups. Among men, those born in Poland and Lithuania are specifically noted as having lower LE and DFLE.
A different pattern appeared for some South Asian female migrant groups: women born in Pakistan and Bangladesh had higher LE but lower DFLE than their England & Wales-born counterparts, indicating longer lives accompanied by greater burdens of disability.
Across the three time windows, these patterns were largely consistent, demonstrating persistent heterogeneity rather than a uniform convergence or divergence over time.
By estimating both LE and DFLE for a detailed set of countries of birth using total-population data, this study extends the migrant-health evidence base beyond single-outcome studies and broad regional groupings. The findings emphasise that migrants are not a homogeneous population: some groups enjoy an advantage in both mortality and disability, while others face higher mortality, higher disability, or the combination of longer lives with more years lived with disability.
The coexistence of higher life expectancy with greater disability for some groups highlights the importance of pairing quantity and quality metrics when planning health, social care, and welfare services. The study also demonstrates the value of high-granularity administrative and census data linked to vital statistics for monitoring population health across diverse migrant groups.
Limitations related to data and measurement are noted implicitly by the authors’ reliance on census-based self-reported LLTI and the ONS’s pre-release item editing and imputation procedures; specific sensitivity analyses or uncertainty intervals are not detailed in the abstract and main summary available here.
The analysis used bespoke ONS census tables for LLTI and population counts and ONS mortality tables for deaths by country of birth, sex and age. The authors list the ONS bespoke table identifiers and indicate these tables are publicly available. The study covered three overlapping 3-year death periods (2000–02, 2010–12, 2020–22) and census-based LLTI prevalence from 2001, 2011 and 2021.
Results indicate the need for targeted public health and social care responses tailored to specific migrant groups. Some migrant populations would benefit from interventions addressing premature mortality, others from services aimed at reducing disability burden and improving healthy ageing. Monitoring both LE and DFLE by detailed country of birth can better inform resource allocation, long-term care planning, and prevention strategies than mortality metrics alone.
The study supports ongoing use of linked, high-granularity administrative and census data to identify vulnerable migrant groups and to guide evidence-based policy making.