Socioeconomic deprivation, mortality and health of within-city migrants: a population cohort study.

BACKGROUND: Evidence linking selective migration (the situation where people in good health move from deprived to affluent areas, whilst people in poor health move in the opposite direction) within local areas to mortality is inconclusive. METHODS: Mortality in within-city migrants was examined using a Sheffield population cohort, adjusted for moves to care homes. The cohort comprised 310 894 people aged 25+ years in 2001 followed up for 9.18 years, with 42 252 (13.6%) deaths. Information on pre-existing medical conditions, socioeconomic indicators and smoking was available from a sample survey. RESULTS: Relative risks (95% CI) of mortality in migrants from deprived to affluent areas were lower compared with people remaining in deprived areas; 0.53 (0.42 to 0.65), 0.70 (0.61 to 0.80), 0.76 (0.68 to 0.86), 0.93 (0.88 to 1.00) and 0.98 (0.93 to 1.03) in the 25-44, 45-64, 65-74, 75-84 and 85+ year age bands, respectively. They also had lower prevalence ORs (95% CI) for bronchitis (0.59 (0.39 to 0.89)), asthma (0.70 (0.53 to 0.93)), depression (0.59 (0.38 to 0.94)), and were less likely to receive benefits (0.60 (0.47 to 0.76)) and less likely to smoke (0.66 (0.51 to 0.85)).Conversely, mortality relative risks in migrants from affluent to deprived areas were higher compared with people remaining in affluent areas; 1.71 (1.37 to 2.12), 1.59 (1.40 to 1.82), 1.44 (1.26 to 1.63), 1.18 (1.10 to 1.27) and 1.04 (1.00 to 1.09) in the corresponding age groups. They also had higher prevalence odds ratios for long-term illness (2.37 (1.71 to 3.29)), asthma (1.71 (1.25 to 2.35)), diabetes (3.03 (1.70 to 5.41)), depression (2.71 (1.74 to 4.21)), were more likely to receive benefits (2.25 (1.65 to 3.07)) and more likely to smoke (1.51 (1.12 to 2.05)). CONCLUSIONS: People moving from deprived to affluent areas had lower mortality and better health, and vice versa, especially in the younger age groups. This study provides strong evidence linking selective migration within local areas to mortality.