Burden and management of multimorbidities among migrants

Why the research is needed

Gaps in migrant and ethnic minority health during the COVID-19 pandemic increased attention on the health status of migrants and the best way to provide health care for these populations. Data also showed that migrants usually present for care late, especially for communicable diseases, which exacerbates other health conditions and leads to further complications. In the UK, there have been links between the general lower health care utilisation among migrants compared to the UK-born population, yet only a few studies on multimorbidity among migrants have been carried out, and no recent review has been conducted on the prevalence of comorbidities, including communicable and chronic diseases, in recent migrants. Early diagnosis and management of multimorbid cases are vital for preventing morbidity, mortality, onward transmission of communicable diseases, and improving overall health outcomes.

What is already known about the subject

The Office for National Statistics (ONS) estimates that 9.5 million people in the UK are non-UK-born and that the annual average migration was 266,000 from 2015 to 2019. These populations are heterogeneous based on their origins, language, and migration histories, and evidence shows an association between migration and multimorbidities. Some studies have shown that, in general, migrant population health status is often better at arrival (the “healthy migrant effect”), but this rapidly declines with increased length of stay in the host country. Also, some migration pathways have been observed to increase vulnerability due to environmental, social, behavioural and psychological risks during and after the migration process. Furthermore, complex patterns that have emerged from experiences with multiple health conditions among migrant groups are sometimes greater than those of host country populations.

Who we will be working with

Organisation/Community partners:

• Office for National Statistics (ONS)
• Leicester Real World Evidence Unit (LRWEU)
• UK-REACH study collaboration
• Centre for Ethnic Health Research (CEHR)
• University of Nottingham
• University of Leicester
• Migrant supporting organisations
• Researchers and clinicians

How patients and the public are involved

Prior to the grant application for these studies, patient and clinician representatives’ feedback on migrant health was obtained from the UK-REACH project, a study that collects evidence on COVID-19 outcomes amongst ethnic minority HCW. The findings showed evidence gap in managing multiple health conditions among recent migrants, which was emphasised more by the COVID-19 pandemic, the effect it had on those with certain chronic diseases like diabetes, and the related long-term impact. As such, the intended output from this project was indicated to be of significant public health and clinical importance by healthcare providers.

A specific PPIE group consists of recent migrant patients, carers, researchers, and healthcare professionals for these projects. This group will meet throughout the project and contribute at most stages, including finalising the research question objective (e.g., exploring other outcomes important to patients, practitioners and policy recommendations), discussing findings, and planning the dissemination of the results. This group will bring their lived experience, range of different skills and perspectives to the project, contribute to finalising the research questions and objectives, discuss the findings and implications, support the drafting of a policy and advocacy document, and plan the dissemination of the findings. The PPIE will be conducted as a focus group or one-to-one discussions, in-person or virtually, depending on availability, appropriateness and restriction guidelines. This group will be supported and facilitated by ARC-EM and the Center for Ethnic Health Research (CEHR)

What we will do

Firstly, we will conduct a systematic review to assess the global burden and management of multimorbidities among migrants.

We will then conduct a retrospective longitudinal study using anonymised patient data from Hospital Episodes Statistics (HES), ONS mortality and census data. This project will take place in the ONS trusted research environment. ONS hosts the Public Health Research Database, which contains data from ONS and NHS Digital data for the population of England and includes both 2011 and 2021 census data, secondary care (HES), primary care (General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR)), and mortality statistics.

What the benefits will be

Findings will present a holistic picture of the complex disease burden among migrant populations and highlight the effect of barriers such as disadvantages linked to migration status.

The review will provide evidence on the effects of multimorbidity needs, healthcare utilisation, and effective health interventions among migrants needed to improve migrant health care policies and practices.

The study will also provide evidence that will help in the development, applicability and successful integration of relevant interventions into current delivery systems for recent migrants. Such targeted health services would help reduce health inequities faced by migrant populations.

When the findings will be available

The findings will be available in April 2024.

How we are planning for implementation

Engaging different stakeholders, including migrants and voluntary sector organisations in a PPIE group to contribute to planning, development, and dissemination often study.

Working with ONS to access needed migrant health data, support analysis, and publicise the research.

Contact 

Dr Winifred Ekezie, wce2@leicester.ac.uk.