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The Office for National Statistics, have released data on ethnic differences in life expectancy and mortality from selected causes in England and Wales: 2011 to 2014.
Prof Gavin Sandercock, Professor in the School of Sport, Rehabilitation and Exercise Sciences, University of Essex, said:
“Everybody has to die of something regardless of their history or heritage – and any group comparison someone has to come bottom of the table.
“Nearly everyone alive today can expect to celebrate their 80th birthday and women can expect to see a good few more.
“Taking everyone into account – difference in life expectancy from the bottom group to the top is about four years in men and five years for women.
“Five extra years of life is an important difference – but the disparities are not as widespread or as clear as they seem.
“The report sounds like bad news for white people living in Britain today but there are two reasons why this may not be the case. First, white people accounted for over 96% of all the deaths recorded in the study so we can be pretty sure that the figures for white people are an accurate representation of the population as a whole. Women who identified as Black African and men who said they were Asian (other) lived the longest but even put together these two groups make up just half of one percent of the people in the study.
“Ignoring (for now) figures for some of the very small groups used in the report (<1% of the population) the differences in life expectancy between groups are < 3years (men) and <2.5 years (women).
“The size and make-up of the groups being compared might also explain why, even when we take into account how many people there are and how old they are, White people seem to come out worst.
“Around 90% of Black Africans and 95% of Other Asians whose deaths were recorded were immigrants to the UK. In contrast >95% of the white people who died in the UK were also born in the UK. The death rates for Asians and Black Africans born in the UK are close to DOUBLE that of those who arrived in the UK after 1991. This doesn’t mean living in the UK is bad for you – but it tells us more about who does (and who does not) emigrate or immigrates.
“Immigrants as a whole are what we call a selective sample – they are people who have made the decision and usually invested great time and effort to move to another country. As such immigrants are likely to be in good health.
“At the very least they’re unlikely to have chronic long-term conditions – people dying of cancer or heart disease really decide to go and work in another country.
“The study covers the deaths of 1.46 million individuals – of which 1.41 million were White. The 96% of deaths recorded were in white people, most of whom were born in the UK.
“For this group we see the opposite of the ‘healthy immigrant effect’. A White British person who develops a chronic disease is unlikely to suddenly emigrate – they are more likely to stay in the UK, close to family friends and to the NHS. When they die they are added to the death statistics.
“The differences in the study may be important but they aren’t huge. The biggest differences are between very small groups of people and these people are not representative of those groups as a whole.”
Dr Raghib Ali, Senior Clinical Research Associate, MRC Epidemiology Unit, University of Cambridge; Honorary Consultant Physician in Acute Medicine, Oxford University Hospitals NHS Trust, said:
“Today’s ONS release of life expectancy by ethnic group in England and Wales is a landmark contribution to the field of health inequalities in relation to ethnicity.
“In contrast to the previously widely held view that ethnic minorities have universally worse health outcomes compared to Whites, these results show that the picture is much more mixed with ethnic minorities generally having higher life expectancy and lower overall mortality than Whites.
“It shows significant differences between ethnic groups for different diseases with for example South Asians having lower rates of cancer but higher rates of heart disease and as cancer has become the predominant cause of premature mortality in England over the last 20 years, this has led to an overall advantage for South Asians. This may be partly be driven by lower rates of tobacco and alcohol use, particularly amongst females.
“There is also likely to be a healthy migrant effect, particularly for more recent migrants (especially Black Africans) who have moved to UK to study or take up employment – but further research is required to understand the causes of these differences.
“These are the first estimates of life expectancy by ethnic group in England and Wales and the findings are consistent with other analyses by Public Health England and Opensafely over the last year again showing lower overall mortality for Asians and Blacks. All of these analyses now show clearly that the disproportionate impact of Covid on some ethnic groups has reversed their previous mortality advantage – not exacerbated a previous disadvantage.
“This analysis also has significant advantages due to its very large sample size and the fact there is no missing ethnicity data and ethnicity is all self-assigned as it is linked to the 2011 census. Therefore, these are the most reliable estimates of life expectancy and mortality by ethnic group to date.
“The findings are particularly surprising for Pakistanis and Bangladeshis as these groups are more likely to be deprived and deprivation is a key driver of life expectancy. This paradox may be explained by the different relationship between deprivation and key risk factors such as tobacco use, alcohol use, and obesity as well as with educational attainment. Also, elderly Pakistanis and Bangladeshis are much more likely to live in multi-generational households – a living arrangement which is generally advantageous to health – but tragically has had the opposite effect with COVID (as well as with influenza and other respiratory infections in the past.”
Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:
“There really hasn’t been very good data in England and Wales, up to now, comparing death rates in different ethnic groups. That’s because most of the ONS data on mortality come from the process of death registration, and people’s ethnicity isn’t recorded on their death certificate in England and Wales. These new findings come from a process of linking the information on ethnicity that people gave in the 2011 Census to their NHS records. That matching process can’t be absolutely perfect, and various adjustments have to be made (including adjustments to allow for further migration). Since this is the first time that this statistical analysis has been done, the results are labelled as Experimental, and there may well have to be changes in the detail of what’s done in the future. But the general approach does seem appropriate to me, and I think the resulting data are of pretty good quality. The statisticians did manage to link 95% of the individuals counted in the 2011 Census to a register that provides their NHS number. That’s pretty impressive, though a snag is that there were differences between ethnic groups in the percentage that were matched.
“The main findings certainly do seem statistically secure to me. The ethnic groups that had the lowest life expectancy at birth, based on data from 2011 to 2014, are the White and Mixed ethnic groups. And the differences in life expectancy are quite marked. For females, those in the White and in the Mixed ethnic groups had a life expectancy at birth of 83.1 years, while those in the Black African group has a life expectancy nearly six years greater, at 88.9. For males, those in the White and Mixed groups had life expectancies of 79.7 and 79.3 years respectively, while those in the Asian Other group (Asian, but not Indian or Bangladeshi or Chinese) had a life expectancy nearly 5 years greater at 84.5, while males of Black African ethnicity weren’t too far behind at 83.8.
“That’s all very interesting, but doesn’t tell us why those differences occur. The ONS statisticians throw some light on this by also calculating age-standardised mortality rates (ASMRs) for all the ethnic groups, for all causes of death taken together, and also for deaths from certain specific causes. Briefly, comparing ASMRs is a way of comparing the numbers of people in different ethnic groups who die in the course of a year, while taking into account how many people there are in each ethnic group, and also the ages of the people in the group. Other things being equal, you’d obviously expect there to be more deaths in a larger group of people, and also more deaths in a group of people that are older on average, and the ASMRs allow for these differences. The detailed ONS data provide information on several different causes of death, and it’s impossible to summarise all that briefly. But, importantly in my view, ONS found that mortality from cancer in males and also in females was highest in the White ethnic group, by some margin (except in comparison with those of Mixed ethnicity). For White males, on average in the years 2012 to 2014, about 1 in every 250 people aged 10 and over died of cancer each year, and the corresponding figure for White women was about 1 in 380. The figures for men and women of Indian ethnicity were, respectively, 1 in 520 and 1 in 690. (This is after the ‘standardisation’ adjustment for different patterns of age.) For several other causes of death, the comparisons went the other way. Mortality from diseases of the circulation (heart disease, strokes, etc.) was more common in several ethnic groups, particularly some of South Asian origin, than for people with White ethnicity. But, while deaths from circulatory diseases are relatively common in the UK, deaths from cancer are even more common. Cancers caused about three in every five deaths of men in England and Wales in the population studies in this report, and a little over half of the deaths of women. Thus, ONS conclude, and I agree, that an important reason for the lower life expectancies in people of White ethnicity is because they have higher death rates from cancers.
“What this doesn’t tell you, and an analysis like this can’t possibly tell you, is why (in England and Wales) people of White ethnicity have higher death rates from cancer than most other ethnic groups, or why some Asian groups have higher death rates from circulatory diseases. The ONS bulletin does have a section describing possible causes, and though it points out that their analysis does match previous research to a considerable extent, these conclusions are based very little on data from this specific new study. In terms of health and mortality generally, ONS point out that some of the ethnic groups (particularly Black African and Asian Other) contain a high proportion of recent migrants, and that other studies have found that people who migrate tend to be healthier than others. Other studies have found fairly similar patterns of disease across ethnic groups as was found for specific causes of death in this new ONS study, though not every detail matches up. Some previous research has found that some behaviours that have harmful effects on health, such as drinking alcohol or smoking tobacco, are more prevalent in people of White ethnicity than in several other ethnic groups. But how all this might fit together is unclear, and ONS promise more research. One aspect that analysis of the ONS data might throw more light on, but has not done so yet, is how the three-way pattern of ethnicity, deprivation, and health operates.
“This report covers only England and Wales. Ethnicity has been recorded on death certificates in Scotland since 2012, on a voluntary basis, so that people who register a death are asked whether they are willing to provide the information. However, some previous analyses of deaths in Scotland by ethnicity have found problems with the recorded ethnicity on death certificates.
“Although this new ONS data release and bulletin seem to have nothing to do with Covid-19 and cover a period long before Covid emerged, in a sense the roots of this analysis do lie in Covid-19 statistics. The concern, which began early in the pandemic, about differences between ethnic groups in rates of severe illness and death led to the method of matching health records to Census records that was used in this new research.”
Declared interests
Prof Gavin Sandercock: “No conflicts of interest to disclose.”
Prof Kevin McConway: ““I am a Trustee of the SMC and a member of its Advisory Committee. My quote above is in my capacity as an independent professional statistician.”
None others received.