Multimorbidity in Latin American migrants of Lambeth – a retrospective cohort study using electronic health records

Problem

The Latin American population is one of the UK’s fastest growing migrant populations. Census data from 2011 recorded around 113,000 first-generation Latin American migrants in the UK, of whom almost 10,000 lived in the borough of Lambeth. Little is known about the chronic health needs of Latin Americans, who tend to work in low-skilled employment despite high levels of educational attainment in Latin America. Understanding this population better may help to design health services to accommodate them. We aimed to determine the prevalence of long-term conditions (LTCs) in Latin Americans residing in the UK, and whether they are healthier than other ethnic groups in Lambeth. We also aimed to assess how being a non-English speaker is associated with LTC incidence.

Approach

This study used Lambeth DataNet, an anonymised 16-year cohort of around 850,000 adult patients derived from electronic primary care records in a primarily young, multi-ethnic and deprived area of south London.Latin Americans were identified by clinical codes representing country of origin, self-reported ethnicity, and main language spoken, and validated against census data. We used clinical codes for 32 key LTCs in urban populations. We estimated the rate of acquisition of LTCs through the life course using survival analysis. Cox regression with random effects estimated how domains of neighbourhood-level deprivation and being a non-English speaker affected the development of multiple LTCs.

Findings

We identified 26,289 Latin Americans in this cohort, approximately 3% of the GP-registered population of Lambeth. Compared to 2011 census data, approximately one-fifth of Latin Americans are not registered with a GP. Latin Americans tended to be older than other Lambeth residents (median age 32 at registration, vs 30 for non-Latin Americans). 16% of Latin Americans recorded English as their main spoken language , compared to 75% of non-Latin Americans. Interim findings suggest that the hazard of most LTCs was lower in Latin Americans than non-Latin Americans, particularly chronic obstructive pulmonary disease (adjusted hazard ratio (HR) 0.35 compared to white ethnicities, 95% CI 0.27-0.45) and alcohol dependence (adjusted HR 0.37, 0-32-0.43). Rates of HIV were 25% higher than White ethnicities (adjusted HR 1.27, 1.19-1.36) - a similar rate to Black ethnic groups. After adjustment for confounders, being a non-English speaker was associated with similar or reduced rates of LTC diagnoses.

Consequences

We used routinely-collected clinical data to identify an migrant group not recognised by the 2011 Census. Around one-fifth of Latin Americans may not be registered with a GP; the majority do not speak English fluently. This may affect access to health care. There is a substantial burden of HIV in this population. These data will help to inform public health decisions to promote health to this migrant group.