Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK.

Neha Pathak,Arturo Gonzalez-Izquierdo,Robert W Aldridge,Pam Sonnenberg,Yamina Boukari,Claire X Zhang,Andrew Hayward,Rachel Burns,Spiros Denaxas,Rohini Mathur

doi:10.3390/ijerph182413304

Abstract

International migrants comprised 14% of the UK’s population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.

Highlights

We aimed to develop a migration phenotype for United Kingdom (UK) National Health Service (NHS) primary care electronic health records (EHRs) and assess its validity in individuals of all ages by describing completeness of recording of migration status, as well as representativeness compared to the Office for National Statistics (ONS) country of birth and 2011 census statistics
Migration status was underCPRD GOLD compared to ONS data, in individuals over the age of 50 years, recorded in Clinical Practice Research Datalink (CPRD) GOLD compared to ONS data, in individuals over the age but increased over the years to capture a quarter of the expected proportion of migrants of 50 years, but increased over the years to capture a quarter of the expected proportion by 2018
We used a migration phenotype to identify a large cohort of the UK migrant population and demonstrated the feasibility of using CPRD GOLD to undertake large-scale populationbased migration health research in the UK

Summary

Introduction

In 2020, international migrants comprised 14% of the United Kingdom (UK) population [1]. Conditions prior to, during and after migration expose individuals to a range of health risks, resulting in differences in health outcomes between migrants and nonmigrants in the migrant’s country of arrival [2]. In the UK, there are well-established multi-generational minority ethnic communities but a history of ‘hostile’ migration policies [3]. The study of migrant health is needed to complement the study of ethnic inequalities to understand how migration intersects with ethnicity, as well as its effects over 4.0/).

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