Dr Matt Wallace
27th April 2026
Are international immigrant populations living longer lives in worse health compared to non-migrant populations? What are the consequences of this for immigrants and wider society? These are the questions that Dr. Daniela Foresta, Dr. Courtney Franklin, Dr. Joe Harrison, and I (Dr. Matt Wallace) are aiming to answer through the £1.3 million UKRI Horizon Europe Guarantee Grant (ERC Starting Grants 2023) project that began in late November 2024. To do this, we are fitting advanced quantitative statistical methods on exhaustive total population data from the four Nordic countries (Denmark, Finland, Norway and Sweden) and the UK.
What does the research already show?
Research consistently documents lower mortality among immigrant populations that can persist for many decades after arrival in the host country. In contrast, while better health has been reported among immigrants—particularly after they have just arrived to live in the new country—their better health compared to non-migrants is fleeting and regularly reverses to comparatively worse health with increased time spent living in the host country. How do we reconcile this accelerated health deterioration among immigrants after arrival with their persistent low mortality risks when good health is a clear prerequisite for a long life? This “Migrant Morbidity Mortality Paradox” is precisely what we want to get to the heart of.
Why is it important to study this?
Immigrants comprise substantial shares of the resident populations of high-income countries. In the past few decades, we have witnessed major growth in the number of older immigrants living in major migrant-receiving countries. Many immigrants are now reaching ages where poor health, chronic conditions, and multimorbidity become common. Contrary to beliefs that immigrants would return to their countries of birth upon retirement, immigrants are instead “ageing-in-place” in their resident countries. All of this has implications for immigrants (their quality of life, social vulnerability, and ability to age well), wider systems (the capabilities of health care and welfare systems to accommodate immigrants’ unique, diverse and complex needs), and wider population health (as immigrant health and mortality affects national health metrics that directly inform resource allocation and a wide array of public health policies.
What have we found so far?
Dr. Courtney Franklin, Dr. Joe Harrison and I published a comprehensive review on this topic that can be found here in the British Medical Bulletin. The main takeaway was thatevidence of poor health with low mortality is disproportionately reported among migrants (especially women) that are born in low- middle-income countries and move to high-income countries.
What are we doing now?
Various different analyses are being conducted right now using the Swedish total population registers and, in particular, the in-patient, out-patient and cause-of-death registers. Dr. Joe Harrison is fitting a series of “illness-death” (survival) models that investigate the transitions from being “healthy” to “diagnosed” and from “diagnosed” to “dead” from specific diseases, focusing on six leading causes-of-death in Sweden (Ischaemic Heart Disease [IHD], Lung Cancer, Prostate Cancer, Breast Cancer, Colorectal Cancer, Stroke and Chronic Obstructive Pulmonary Disorder [COPD]). Joe’s analysis has the potential to tell us which diseases are driving the overall migrant morbidity-mortality paradox across different migrant populations.
Dr. Daniela Foresta and Dr. Courtney Franklin, meanwhile, are fitting a series of latent class analyses that aim to identify specific hidden (or “latent”) diseases classes (or combinations, with a focus on multimorbidity) within Sweden. Their analyses have the potential to tell us what combination of diseases are most prevalent across immigrant populations, whether immigrants exhibit unique combinations of diseases compared to non-migrants, and whether the mortality of migrants and non-migrants with similar multimorbidity profiles diverges.
The team will be presenting preliminary results from these exciting new analyses at the CRIS seminar on the 30th of April at 15h00. Be sure to go along and hear what they have to say!
Where can you find updates on our work?
Key updates on the PARA-MOR project can be found on our X (@para_mor_ukri) and BlueSky (@para-mor-ukri.bsky.social) accounts. We also have a working paper series that can be found here that includes additional work relating to disability-free life expectancies among migrants living in England & Wales (Dr. Joe Harrison), the impact of refugees on life expectancy in Sweden before, during, and after COVID-19 (Dr. Daniela Foresta), and the impact of immigrants on regional life expectancies within Sweden (Dr. Courtney Franklin). You can also email the Lead Researcher Dr. Matt Wallace at m.j.wallace@salford.ac.uk.
Dr Matt Wallace an Associate Professor and Reader in Social Inequality at the Centre for Research on Inclusive Society (CRIS) at the University of Salford.
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