Have your say on migrant health research in OpenSAFELY

We are starting a new project to see how OpenSAFELY could be used to conduct important research on migrants’ physical and mental health. I’ll be leading this project, as part of a 3-year fellowship at Jesus College and the Bennett Institute, funded by the Peter Bennett Foundation.

Migrants may experience health inequities, but we need more evidence to help address them

People who have migrated to England are at risk of experiencing health inequities, which are defined as unfair and avoidable differences in health. The NHS has placed addressing health inequities at the centre of achieving its goals. To address those inequities, we need to understand them.

GP records - like the ones already available in OpenSAFELY - are potentially helpful, but in the UK we don’t routinely record a person’s migration status in their GP record. So we need to use other information in the GP record to determine if someone is a migrant.

Using codelists to determine if an individual in the data is a migrant

When you go to see your GP, they make notes on a computer, which are added to your electronic health record. These notes can take the form of codes. These codes often relate to a clinical condition, but sometimes they’re about specific characteristics, like migration or your living circumstances.

For example, based on a conversation or your GP surgery registration form, a member of the practice staff might input a code that indicates that you were born in a different country, and are by definition a migrant - for example, “315367001”, which corresponds to “Born in Algeria”.

We can collect all the codes (e.g. place of birth) related to migration status into a codelist, then use this codelist to find all people who have such a code in their electronic health record. The list of people identified is called a cohort, with this list being a “migrant” cohort.

OpenSAFELY’s huge potential for understanding migrants’ health

In this project, we propose to update and use a migration codelist to search the data held in OpenSAFELY - which is an analytics platform that allows researchers to analyse GP data for approximately 58 million patients without directly seeing the individual patient-level information. Instead, researchers write their analysis code on dummy data (i.e. data that looks similar to the real data, but isn’t real patients’ data). When they are happy with the code, they then run it on the real data in OpenSAFELY and are shown only the aggregated results (our explainer video tells you all the basics in 3-4 minutes).

By applying the migration codelist to OpenSAFELY we could create a migrant cohort – essentially a group of anonymous individuals across the UK who are likely to be migrants. We can use this cohort in NHS England-approved research studies to understand more about migrants’ health needs. We would specifically like to:

• create a map of the physical and mental health conditions that affect migrants of different age ranges.
• investigate differences in diagnosis rates for certain important physical and mental health conditions between people who are migrants and who are not migrants.
• create a more specific cohort of more vulnerable migrants, such as refugees, asylum seekers and irregular migrants.

Addressing risks and concerns

There are various risks in doing this type of research. The main risk is that by making it possible to apply a migration codelist in OpenSAFELY, it could be misused in future to conduct analyses that intentionally promote anti-migrant and racist ideologies.

Some people may also be concerned about their immigration status being added to their health record in light of previous data sharing concerns between NHS Digital and the Home Office for immigration enforcement purposes. For this reason, we are conducting extensive stakeholder engagement with migrants, GPs and other relevant organisations to give people the chance to shape the proposed plans and to ensure that the research is conducted in a way that carefully considers and mitigates any risks. We will also carefully consider the ethical aspects of this work. The proposal will then be submitted to NHS England for their consideration.

If you are interested in this work, we would love to hear from you. You could be a researcher, or someone who provides care and support for migrants, or who has lived experience! Please get in touch by emailing migrant-study@opensafely.org.