Abstract

BackgroundMortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important.MethodsThis study investigated daily death counts collected within the Sample Vital Registration System (VSRS) established by the Bangladesh Bureau of Statistics (BBS). The sample was stratified by location (urban vs. rural), gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects.ResultsWe found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults.ConclusionThis study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have been, and still are, associated with a marked excess of mortality in summer, only a weakly pronounced secondary summer peak could be observed for Bangladesh, possibly due to the reduced incidence of diarrhoea-related fatalities. These findings suggest that Bangladesh is undergoing an epidemiological transition from summer to winter excess mortality, as a consequence of changes in socioeconomic conditions and health care provision.

Highlights

  • Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to longterm influences of meteorological conditions

  • A number of 640 Primary Sample Units (PSU) is located in rural areas, comprising 132,646 households; 280 PSUs are located in urban areas with 57,852 households and 80 PSU are placed in the statistical metropolitan area (SMA) with 16,024 households

  • Diarrhoeal disease only accounted for approximately 4%, while vector-borne diseases and malnutrition accounted for approximately 2% of all deaths on average

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Summary

Introduction

Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to longterm influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Seasonal variations are to some extend driven by seasonal variations in weather, they underlie various non-atmospheric influences. These influences have fundamentally modified the shape of the seasonal pattern over recent centuries [5,19,20,21,22]. The modifying effect of non-atmospheric parameters is well-demonstrated by the existence of different seasonality regimes within the same climatic region. In a more recent study, education serving as a proxy for socioeconomic status has been highlighted as a determinant for seasonal fluctuations of mortality [5]

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