Immigrant life expectancy and disability-free life expectancy by detailed country of birth in England and Wales: A total population, repeated cross-sectional approach.

Research regularly reports lower mortality among migrants, leading to conclusions of a "Healthy Immigrant Effect". However, evidence on migrant health is less consistent, suggesting a disconnect between mortality and health outcomes. This highlights the need to examine both health and mortality simultaneously rather than relying on single-outcome measures. We estimate life expectancy (LE) and disability-free life expectancy (DFLE) at age 50 for 37 countries of birth in England and Wales. Life tables were constructed using whole-population mortality data from 2000-02, 2010-12 and 2020-22, while DFLE was estimated using the Sullivan method and self-reported limiting long-term illness data from the 2001, 2011 and 2021 censuses. By comparing LE and DFLE with those of the England and Wales-born population across three time points, we assessed differences in both mortality and disability and examined how these changed over time. We find substantial heterogeneity in migrant health. Most migrant populations consistently experienced a "healthy migrant effect", with higher LE and DFLE than the England and Wales-born population at all three time points. In contrast, several of the largest migrant groups exhibited an "unhealthy migrant effect", characterised by lower LE and DFLE (including those born in Scotland, the Republic of Ireland, and men born in Poland and Lithuania), while others experienced longer lives but greater disability burdens, with higher LE but lower DFLE (including women born in Pakistan and Bangladesh). These findings demonstrate that migrant populations are far from homogeneous and some groups face elevated burdens of disability and/or premature mortality and would benefit from targeted public health interventions.