Excess winter mortality in Europe: a cross country analysis identifying key risk factors

• Published in: Journal of epidemiology and community health (1979) Vol. 57; no. 10; pp. 784 - 789
• Main Author: Healy, J D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2003; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Analysis; Biological and medical sciences; Climate; Climate models; Cold Temperature - adverse effects; Cold weather; cross-country analysis; Datasets; Death; Efficiency; Europe; Europe - epidemiology; excess winter mortality; fuel poverty; General populations; Health care; Health Expenditures - statistics & numerical data; Housing; Housing - standards; Humans; Income; Income distribution; Income inequality; Influence; Life Style; Lifestyles; Longitudinal Studies; Macroeconomics; Medical sciences; Mortality; Mortality patterns; Poisson Distribution; Population; Poverty; Poverty - statistics & numerical data; Predisposing factors; Prevention and actions; Public finance; Public health. Hygiene; Public health. Hygiene-occupational medicine; Relative humidity; Research Report; Risk Factors; seasonal mortality; Seasonal variations; Seasons; Socioeconomic Factors; Socioeconomics; southern Europe; Statistics; Studies; Time series; Winter; Europe; United Kingdom > UK; Human; Winter; Seasonal variation; Mortality; Risk factor; Epidemiology; Public health
• ISSN: 0143-005X; 1470-2738; 1470-2738
• DOI: 10.1136/jech.57.10.784

Objective: Much debate remains regarding why certain countries experience dramatically higher winter mortality. Potential causative factors other than cold exposure have rarely been analysed. Comparatively less research exists on excess winter deaths in southern Europe. Multiple time series data on a variety of risk factors are analysed against seasonal-mortality patterns in 14 European countries to identify key relations Subjects and setting: Excess winter deaths (all causes), 1988–97, EU-14. Design: Coefficients of seasonal variation in mortality are calculated for EU-14 using monthly mortality data. Comparable, longitudinal datasets on risk factors pertaining to climate, macroeconomy, health care, lifestyle, socioeconomics, and housing were also obtained. Poisson regression identifies seasonality relations over time. Results: Portugal suffers from the highest rates of excess winter mortality (28%, CI=25% to 31%) followed jointly by Spain (21%, CI=19% to 23%), and Ireland (21%, CI=18% to 24%). Cross country variations in mean winter environmental temperature (regression coefficient (β)=0.27), mean winter relative humidity (β=0.54), parity adjusted per capita national income (β=1.08), per capita health expenditure (β=−1.19), rates of income poverty (β=−0.47), inequality (β=0.97), deprivation (β=0.11), and fuel poverty (β=0.44), and several indicators of residential thermal standards are found to be significantly related to variations in relative excess winter mortality at the 5% level. The strong, positive relation with environmental temperature and strong negative relation with thermal efficiency indicate that housing standards in southern and western Europe play strong parts in such seasonality. Conclusions: High seasonal mortality in southern and western Europe could be reduced through improved protection from the cold indoors, increased public spending on health care, and improved socioeconomic circumstances resulting in more equitable income distribution.