Intergenerational continuities of ethnic inequalities in general health in England.
BACKGROUND
Previous research strongly suggests that ethnic minority groups are more likely to suffer a poorer health profile compared with the overall population, although it is not clear whether these inequalities persist over generations. This study aimed to establish the degree to which ethnic inequalities in health are transmitted from the first to the second generation, and to determine the extent to which intergenerational changes in socioeconomic status and health behaviours might explain any variation that exists.


METHODS
Data from the 1999 and 2004 Health Surveys for England assessed the prevalence of fair/poor general health across first (n = 4492) and second (n = 5729) generations of six ethnic minority populations. A white population was selected as reference (n = 18 407). The risk of fair/poor general health was estimated by applying logistic regression models and stepwise inclusion of demographic, socioeconomic and behavioural variables. Generational movement relative to the white baseline was assessed for all ethnic groups adjusted for age and sex.


RESULTS
No significant differences in levels of reported fair/poor general health were observed between generations. After adjusting for improved socioeconomic position, the second generation became more likely to report worse health, whereas adjusting for differences in health behaviours had no effect. The Bangladeshi population showed significant intergenerational improvement in general health relative to the white reference, showing a reduction in the odds ratio (95% CI) from 2.75 (2.14 to 3.56) for the first generation to 1.58 (1.17 to 2.13) in the second generation.


CONCLUSIONS
Ethnic minorities in England report consistent rates of fair/poor general health across generations, despite the health benefits resulting from upward social mobility. These health inequalities are unaffected by changes in health behaviours. Understanding these intergenerational pathways will have important public health policy implications as the migrant population not only ages, but also reproduces.
Smith
N R
NR
Department of Epidemiology and Public Health, 1-19 Torrington Place, University College London, UK. n.r.smith@ucl.ac.uk
Kelly
Y J
YJ
Nazroo
J Y
JY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data*; D005192:Family Health; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D012923:Social Class; D012937:Social Mobility / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult