Monday, August 27, 2012

Health of Scottish People in England

I've spoken before on the blog about on-going research we are conducting trying to explain well-documented health penalties experienced by certain groups of Irish migrants to England. Naturally,  this has led me to wonder whether Scottish migrants to England had similar experiences. Below is a sample of papers on this issue and it would be very interesting to understand more about the health of Scottish people in England and make comparisons to Irish people in the same age-groups. As in the case of Ireland, such an analysis has implications for understanding health patterns among non-migrant groups in the sending region as selection effects may be present.

Sarah Wild, Paul Mckeigue (1997). Cross sectional analysis of mortality by country of birth in england and wales, 1970-92. Abstract:

Objective: To compare mortalities for selected groups of immigrants with the national average.

Design: Analysis of mortality for adults aged 20-69 in 1970-2 and 1989-92 using population data from 1971 and 1991 censuses. Mortality of Scottish and Irish immigrants aged 25-74 was also compared with mortality in Scotland and Ireland for 1991.

Setting: England and Wales.

Main outcome measures: Standardised mortality ratios for deaths from all causes, ischaemic heart disease, cerebrovascular disease, lung cancer, and breast cancer.

Results: In 1989-92 mortality from all causes was higher than the national average for Scottish immigrants, by 32% for men and 36% for women; for Irish immigrants it was higher by 39% for men and 20% for women; and for Caribbean born men it was lower by 23%. Ischaemic heart disease and lung cancer accounted for 30-40% of the excess mortality in Scottish and Irish immigrants. For south Asians, excess mortality from circulatory disease was balanced by lower mortality from cancer. Standardised mortality ratios for cerebrovascular disease in 1989-92 were highest for west African immigrants (271 for men and 181 for women).

Conclusions: Widening differences in mortality ratios for migrants compared with the general population were not simply due to socioeconomic inequalities. The low mortality from all causes for Caribbean immigrants could largely be attributed to low mortality from ischaemic heart disease, which is unexplained. The excess mortality from cerebrovascular and hypertensive diseases in migrants from both west Africa and the Caribbean suggests that genetic factors underlie the susceptibility to hypertension in people of black African descent.

R Balarajan (1991). Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Abstract:
Objective-To examine mortality from ischaemic heart disease and cerebrovascular disease in England and Wales by country of birth of the deceased.
Design-Standardised mortality ratios were computed by country of birth groups for ischaemic heart disease and cerebrovascular disease for 1979-83 and 1970-2 by using the five year age-sex specific rates for England and Wales for 1979-83 as standard.
Setting-England and Wales 1970-2 and 1979-83.
Results-In 1979-83 mortality from ischaemic heart disease was highest in men and women born in the Indian subcontinent (standardised mortality ratio 136 and 146 respectively). Young Indian men suffered the greatest excess (313 at ages 20-29). Other groups with raised mortality included Irish, Scottish, and Polish born immigrants. Those born in the Caribbean, the old Commonwealth, west Europe, and the United States had low death rates. In England and Wales mortality from ischaemic heart disease declined by 5% in men and 1% in women between 1970-2 and 1979-83, with greatest percentage declines in immigrants born in the United States, South Africa, the old Commonwealth, the Caribbean, and France. Immigrant groups with raised mortality in the earlier period showed little improvement, and mortality from ischaemic heart disease increased among Indians (6% in men and 13% in women). In 1979-83 mortality from cerebrovascular disease was highest in Caribbeans (standardised mortality ratios 176 in men and 210 in women), followed by Africans, Indians, and Irish. Rates were low in west Europeans. Mortality from stroke declined by 28% overall in this period, a rate of decline shared by most groups. Men from the Indian subcontinent showed a decline of only 3%.
Conclusion-In the 1980s mortality from ischaemic heart disease and cerebrovascular disease differed significantly between ethnic groups in England and Wales. In general, ethnic groups that experienced lower mortality from ischaemic heart disease in the 1970s showed the greatest improvement over the following decade.

E. A. Haworth, V. Soni Raleigh & R. Balarajan (1999). Cirrhosis and Primary Liver Cancer Amongst First Generation Migrants in England and Wales.
Ethnicity & Health, Volume 4, Issue 1-2. Abstract:

Objective. To examine mortality from cirrhosis of the liver and primary liver cancer among first generation migrants to England and Wales. Design. Comparison of standardised mortality ratios (SMRs) for cirrhosis of the liver and primary liver cancer in men and women aged 20-69, by country of birth for the five year period 1988-1992. Setting. England and Wales. Results. There was a statistically significant two-fold excess of mortality from cirrhosis of the liver among male migrants from East Africa (SMR 286), India (SMR 261) and Bangladesh (SMR 254) as well as men born in Scotland (SMR 253) and Ireland (SMR252). Among women, only those born in Scotland (SMR 254) and Ireland (SMR 237) showed significant excess mortality. For liver cancer, significant excess mortality occurred among men born in the Caribbean (SMR 312), Bangladesh (910) and the African Commonwealth other than East Africa (1014), with Scottish and Irish born men showing more moderate excesses (136 and 170, respectively). SMRs were elevated also in all groups of foreign-born women but, probably owing to the small numbers of deaths, none of the findings reached statistical significance. Conclusions. Of public healthconcern is the excess mortality from cirrhosis in first generation immigrants to England and Wales from Scotland and Ireland (men and women) and in male migrants from India, Bangladesh and East Africa. Of equal concern is increased mortality from liver cancer in all foreign-born groups of both sexes, particularly among Bangladeshis, and African-Caribbeans. As well as promoting sensible drinking among immigrant men, specific preventive measures for those of Bangladeshi, African-Caribbean origin may include selective screening for hepatitis B and C and other tumour markers. Screening for liver cancer using imaging techniques needs further investigation. The benefit/cost ratio should be assessed by the Screening Committees of the UK Departments of Health. At local level, variation in incidence and prevalence of hepatic disease and feasible prevention programmes should be assessed within developing healthimprovement programmes.

John A. Burnett (2007). ‘Hail Brither Scots O' Coaly Tyne’: Networking and Identity among Scottish Migrants in the North-east of England, ca. 1860–2000.
Immigrants & Minorities, Volume 25, Issue 1.
Despite their significant presence throughout the modern era, Scottish emigrants to England have been neglected as a topic of research. At various times, Scottish in-migration to the north-east of England was greater than any other English region both numerically and proportionately. Its visibility was evident in terms of cultural expression through the myriad organisations established from the 1860s to the 1970s. Scots, and their descendants, made a vital contribution to the economic and political development of the region. This article examines the formation and operation of Scottish ethnic networks. It will explore the wider issue of the nature of Scottish migration to the north-east, the strength of ethnic affiliation within this group and the range of networks used to overcome dislocation or alienation. The central findings draw on a rich variety of sources including the records of local Burns Clubs, St Andrew's Societies and Pipe Bands, supplemented by local press material and oral testimony.

Marmot MG, Adelstein AM & Bulusu L. Immigrant mortality in England and Wales 1970-78: Causes of death by country of birth. OPCS London: HMSO, 1984. (Book)

Ibison JM, Swerdlow AJ, Head JA, Marmot M. (1996). Maternal mortality in England and Wales 1970-1985: an analysis by country of birth. Br J Obstet Gynaecol. 103(10):973-80.
To determine the risk of maternal mortality in immigrants to England and Wales.
Analysis of death registrations, 1970-1985, by country of birth.
England and Wales.
Women dying in England and Wales during pregnancy, childbirth or the puerperium, or dying from malignant tumour of the placenta.
The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause-specific death, adjusted for age, in immigrants compared with women born in England and Wales.
Women born in West Africa (relative risk 10.3; 95% CI 8.0-13.2) and the Caribbean (4.6; 3.8-5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3-2.0) and "Europe and the USSR' (1.7; 1.2-2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the "Rest of the World' and Scotland were at significantly elevated risk.

An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non-immigrants is required, and into whether this affects the risk of maternal mortality.

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