Health of first- and second-generation immigrant children in England and Wales: serial, cross-sectional study using linked Census and birth registration data

IntroductionThere is limited research on the health outcomes of children who have migrated, or whose parents have migrated, to the UK. MethodsWe used linked birth registration and Census data from the 1991, 2001 and 2011 waves of the Longitudinal Study, covering 1% of the England and Wales population. We derived the prevalence of self-or-caregiver reported limiting long-term illness (2001, 2011 Censuses) and poor health (1991, 2001, 2011 Censuses) among household members <18 years old. We defined immigration background using child and parent country of birth. Logistic regression models assessed the association between immigration background and health outcomes. ResultsThe percentage of children who were first-or second-generation immigrants increased from 16.6% (20120/121109) in 1991 to 24.7% (28965/117116) in 2011. We found no evidence of an association between immigration background and health outcomes in 1991. In 2011, children born outside the UK were less likely to report a limiting long-term illness (odds ratio 0.67; 95% confidence interval 0.58, 0.76) compared to average. Also in 2011, children born in the UK to UK-born parents or non-UK-born fathers/UK-born mothers had higher odds of reporting long-term illness compared to average (1.25; 1.17, 1.32 and 1.21; 1.08, 1.36, respectively). In both 2001 and 2011, children born in the UK to non-UK-born parents had the highest odds of reporting poor health. ConclusionWhilst immigrant children with a first-generation immigrant background are less likely to live with limiting long-term illness, evidence-based National Health Service guidelines for supporting second-generation immigrant children are needed. What is already known on this topicO_LIStudies of adults have identified a healthy migrant effect, where immigrants have lower mortality rates than the host population. C_LIO_LIIt is not clear if this applies to children or to non-mortality outcomes. C_LI What this study addsO_LIThere was no association between childrens immigration background and prevalence of long-term illness before 2011, or poor health before 2001. C_LIO_LIFirst generation immigrant children had lower prevalence of limiting long-term illness, and similar prevalence of poor health to non-immigrant children. C_LIO_LIChildren born in the UK to UK-born parents or second-generation immigrant children via the father had higher prevalence of long-term illness, and UK-born children whose parents were both born abroad had higher prevalence of poor health. C_LI How this study might affect research, practice or policyO_LIThe National Health Service should develop evidence-based guidelines for how health services can support second generation immigrant children. C_LI