Abstract
There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999–2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air quality. Models were adjusted for deprivation, an index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p<0.05), suggesting that CHD mortality rates were higher in areas with lower average temperature and hours of sunshine. After adjustment for the unhealthy lifestyle of populations and deprivation, the climate variables explained at least 15% of large scale variation in CHD mortality rates. The results suggest that the climate has a small but significant independent association with CHD mortality rates in England.
Highlights
Geographical inequalities in coronary heart disease (CHD) mortality rates in England are substantial and persistent
A substantial amount of large scale geographic variation in CHD rates is explained by physical environment variables even after adjustment for deprivation, urbanicity and behavioural risk factor profiles of populations – at least 10% of large scale variation in mortality rates
This suggests that the association between climate and CHD mortality rates shown in these analyses may be due to residual confounding, but it should be noted that temporal variations and geographic variations in CHD mortality rates due to temperature are not directly comparable
Summary
Geographical inequalities in coronary heart disease (CHD) mortality rates in England are substantial and persistent. Previous studies that have addressed geographical variations in CHD have either used data on individuals collected from different sites but have been under-powered at the area-level to consider more than one environmental variable simultaneously [12,13], or have used arealevel data and have been unable to adjust analyses adequately for behavioural risk factors for CHD [14,15] This paper addresses these gaps in the literature by reporting an analysis of the association between climate and air pollution and CHD mortality rates in a large dataset of small areas, using an area-level measure of the prevalence of behavioural risk factors introduced, that we have previously used to investigate the role of deprivation and unhealthy lifestyle on geographic variations in CHD [16]. The aim of this is to estimate the amount of geographic variation in CHD mortality rates in England that is a result of climate and air pollution after adjustment for the behavioural risk factor profile of populations, deprivation and urbanicity
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