Scottish Longitudinal Study
Development & Support Unit

Current Projects

Project Title:

Ethnic inequalities in health at the older ages

Project Number:



Genevieve Cezard (University of St Andrews)
Dr Alan Marshall (University of St Andrews)
Dr Nissa Finney (University of St Andrews)
Prof Hill Kulu (University of St Andrews)

Start Date:

1st October 2017


This project aims to understand how ethnic inequalities in health in later life evolve over time by modelling health trajectories in the Scottish context. Exploiting the SLS longitudinal design linked to administrative data it will focus on self-reported health and doctor diagnosed multi-morbidity and the contribution of age, period of migration, time since migration, migrant cohorts and generations in shaping ethnic health inequalities overtime.

Using subjective health and multi-morbidity (see A3.5) as indicators of morbidity, it seeks to answer the following research questions:

  • Do health change vary by ethnic group? Can the potential variation be explained by age and cohort, socio-economic status (SES) and household and neighbourhood risk factors?
  • Do health trajectories in minority ethnic groups vary by period of migration, duration of residence in the UK or migrant generation?
  • Does subjective health trajectories between 2001 and 2011 relate to trajectories of doctor diagnosed multi-morbidity similarly across ethnic groups?

We hypothesise that minority ethnic groups will have an initial health advantage at time of migration compared to the majority White Scottish that will diminish or reverse with acculturation and in subsequent generation of migrants. Thus the health advantage and trajectory might vary by ethnic groups due to differences in health behaviours and experiences of migration. Older migrant cohorts and first generations are likely to be better off in comparison to the younger generations. Finally, the association between subjective health and multi-morbidity trajectories is expected to differ by ethnicity due to differences in health reporting and services.


Becares, L. (2013). Which ethnic groups have the poorest health - Ethnic health inequalities 1991 to 2011. The Dynamics of Diversity series: The Centre on Dynamics of Ethnicity (CoDE), The University of Manchester.
Evandrou, M. (2000a). Ethnic inequality in health in later life. Health Statistics Quarterly 08 (Winter): 20-28.
Evandrou, M. (2000b). Social inequalities in later life: the socio-economic position of older people from ethnic minority groups in Britain. Popul Trends(101), 11-18.
Evandrou, M., Falkingham, J., Feng, Z., & Vlachantoni, A. (2016). Ethnic inequalities in limiting health and self-reported health in later life revisited. J Epidemiol Community Health, 70(7), 653-662. doi: 10.1136/jech-2015-206074
Fischbacher, C. M., Cezard, G., Bhopal, R. S., Pearce, J., & Bansal, N. (2014). Measures of socioeconomic position are not consistently associated with ethnic differences in cardiovascular disease in Scotland: methods from the Scottish Health and Ethnicity Linkage Study (SHELS). Int J Epidemiol, 43(1), 129-139. doi: 10.1093/ije/dyt237
Jasso, G. M., D. S.; Rosenzweig, M. R.; Smith, J. P. (2004). Immigrant health-selectivity and acculturation. In N. B. B. Anderson, R. A.; Cohen, B. (Ed.), Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. (pp. 227-266). Washington, DC: National Academy Press.
Kim, I.-H., Carrasco, C., Muntaner, C., McKenzie, K., & Noh, S. (2013). Ethnicity and Postmigration Health Trajectory in New Immigrants to Canada. Am J Public Health, 103(4), e96-e104. doi: 10.2105/ajph.2012.301185
Marshall, A., Nazroo, J., Tampubolon, G., & Vanhoutte, B. (2015). Cohort differences in the levels and trajectories of frailty among older people in England. J Epidemiol Community Health, 69(4), 316-321.
Nazroo, J. Y. (2004). Ethnic disparities in aging health: What can we learn from the United Kingdom? In N. Anderson, R. Bulatao & B. Cohen (Eds.), Critical Perspectives on Racial and Ethnic Differentials in Health in Late Life. Washington, D.C.: National Academies Press.
Newbold, K. B. (2005). Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Soc Sci Med, 60(6), 1359-1370.
Vandenheede, H., Willaert, D., De Grande, H., Simoens, S., & Vanroelen, C. (2015). Mortality in adult immigrants in the 2000s in Belgium: a test of the ‘healthy-migrant’ and the ‘migration-as-rapid-health-transition’ hypotheses. Tropical Medicine & International Health, 20(12), 1832-1845. doi: 10.1111/tmi.12610
Wallace, M. (2016). Adult mortality among the descendants of immigrants in England and Wales: does a migrant mortality advantage persist beyond the first generation? Journal of Ethnic and Migration Studies, 42(9), 1558-1577. doi: 10.1080/1369183X.2015.1131973

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