Abstract
Background: In 2017, 15.6% of the people living in England were born abroad, yet we have a limited understanding of their use of health services and subsequent health conditions. This linked population-based cohort study aims to describe the hospital-based healthcare and mortality outcomes of 1.5 million non-European Union (EU) migrants and refugees in England. Methods and analysis: We will link four data sources: first, non-EU migrant tuberculosis pre-entry screening data; second, refugee pre-entry health assessment data; third, national hospital episode statistics; and fourth, Office of National Statistics death records. Using this linked dataset, we will then generate a population-based cohort to examine hospital-based events and mortality outcomes in England between Jan 1, 2006, and Dec 31, 2017. We will compare outcomes across three groups in our analyses: 1) non-EU international migrants, 2) refugees, and 3) general population of England. Ethics and dissemination: We will obtain approval to use unconsented patient identifiable data from the Secretary of State for Health through the Confidentiality Advisory Group and the National Health Service Research Ethics Committee. After data linkage, we will destroy identifying data and undertake all analyses using the pseudonymised dataset. The results will provide policy makers and civil society with detailed information about the health needs of non-EU international migrants and refugees in England.
Highlights
What is the percentage of the cohort they expect to have an National Health Service (NHS) number?. What will they do if the Personal Demographics Service (PDS) contains only a third of the migrants who have registered with a general practitioner (GP), as highlighted by Stagg et al.1? I remain sceptical about the PDS having data added through all the sources mentioned on the NHS Digital website and believe the main source of data is from the patients themselves when they register with a new GP
This article summarizes the analysis protocol for a study investigating refugees and migrants originating from non-European Union (EU) countries with a high prevalence of tuberculosis in England
The study will not be representative of international immigration to England because EU-migrants and non-EU migrants from countries with low tuberculosis prevalence cannot be identified
Summary
The authors tell the readers that little research has been conducted on mortality among international migrants in England. While this is (I think) accurate for access to health services and health, this is less true for immigrant mortality. It would be accurate to state that there is a lack of national data sources in England that have the relevant information to be able to identify refugees (which would require information on country of birth, reason for arrival, visa type etc...). I recommend the authors re-frame their introduction around the migrant subgroups they are studying, place their study in the context of the previous literature on migrant mortality in England 1-14, and be more explicit in their phrasing
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