Excess winter mortality in Europe: a cross country analysis identifying key risk factors
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Open Access
- 1 October 2003
- journal article
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 57 (10), 784-789
- https://doi.org/10.1136/jech.57.10.784
Abstract
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.Keywords
This publication has 20 references indexed in Scilit:
- Mortality and bioclimatic discomfort in Emilia-Romagna, ItalyJournal of Epidemiology and Community Health, 2002
- Individual income, income distribution, and self rated health in Japan: cross sectional analysis of nationally representative sampleBMJ, 2002
- Education, income inequality, and mortality: a multiple regression analysisBMJ, 2002
- A comparison of body mass index, waist–hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam studyInternational Journal of Obesity, 2001
- The impact of income inequality on individual and societal health: absolute income, relative income and statistical artefactsHealth Economics, 2001
- Seasonal variation in mortality in ScotlandInternational Journal of Epidemiology, 2000
- The Decline in Winter Excess Mortality in The NetherlandsInternational Journal of Epidemiology, 1991
- Health Services Resources and their Relation to Mortality from Causes Amenable to Health Care Intervention: A Cross-National StudyInternational Journal of Epidemiology, 1988
- National incomes and health: implications of some recent additions to the data.1981
- Schizophrenia and Social ClassThe British Journal of Psychiatry, 1963