Deaths In London Research Articles

Contribution of Cold Versus Climate Change to Mortality in London, UK, 1976-2019.

Objectives. To quantify past reductions in cold-related mortality attributable to anthropogenic climate change. Methods. We performed a daily time-series regression analysis employing distributed lag nonlinear models of 1 203 981 deaths in Greater London, United Kingdom, in winter months (November-March) during 1976 to 2019. We made attribution assessment by comparing differential cold-related mortality impacts associated with observed temperatures to those using counterfactual temperatures representing no climate change. Results. Over the past decade, the average number of cold days (below 8 °C) per year was 120 in the observed series and 158 in the counterfactual series. Since 1976, we estimate 447 (95% confidence interval = 330, 559) annual cold-related all-cause deaths have been avoided because of milder temperatures associated with climate change. Annually, 241 cardiovascular and 73 respiratory disease deaths have been avoided. Conclusions. Anthropogenic climate change made some contribution to reducing previous cold-related deaths in London; however, cold remains an important public health risk factor. Public Health Implications. Better adaptation to both heat and cold should be promoted in public health measures to protect against climate change. In England, this has been addressed by the development of a new year-round Adverse Weather and Health Plan. (Am J Public Health. 2024;114(4):398-402. https://doi.org/10.2105/AJPH.2023.307552).

Tracking the incidence and risk factors for SARS-CoV-2 infection using historical maternal booking serum samples.

The early transmission dynamics of SARS-CoV-2 in the UK are unknown but their investigation is critical to aid future pandemic planning. We tested over 11,000 anonymised, stored historic antenatal serum samples, given at two north-west London NHS trusts in 2019 and 2020, for total antibody to SARS-CoV-2 receptor binding domain (anti-RBD). Estimated prevalence of seroreactivity increased from 1% prior to mid-February 2020 to 17% in September 2020. Our results show higher prevalence of seroreactivity to SARS-CoV-2 in younger, non-white ethnicity, and more deprived groups. We found no significant interaction between the effects of ethnicity and deprivation. Derived from prevalence, the estimated incidence of seroreactivity reflects the trends observed in daily hospitalisations and deaths in London that followed 10 and 13 days later, respectively. We quantified community transmission of SARS-CoV-2 in London, which peaked in late March / early April 2020 with no evidence of community transmission until after January 2020. Our study was not able to determine the date of introduction of the SARS-CoV-2 virus but demonstrates the value of stored antenatal serum samples as a resource for serosurveillance during future outbreaks.

Effect of environmental pollution PM2.5, carbon monoxide, and ozone on the incidence and mortality due to SARS-CoV-2 infection in London, United Kingdom

ObjectivesCOVID-19 pandemic raised several queries on the relationship between the environment pollution and occurrence of new cases and deaths. This study aims to explore the effect of environmental pollution, particulate matter (PM 2.5 μm), carbon monoxide (CO) and Ozone (O3) on daily cases and daily deaths due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a largest metropolitan city London, United Kingdom. MethodsFor this study, we selected London, one of the highly populated capitals, and markedly affected due to COVID-19 pandemic. The data on the SARS-CoV-2 daily new cases and deaths were recorded from UK-gov Web "Coronavirus COVId-19 in the UK, 2020". The daily environmental pollutants PM 2.5 μm, CO and O3 were recorded from the metrological web "(London Air Pollution, Air Quality Index- AQI, 2020)". The daily cases, deaths, PM 2.5 μm, CO and O3 were documented from the date of the occurrence of the first case of SARS-CoV-2 in London, February 24 to November 2, 2020. ResultsThe SARS-CoV-2 cases and deaths were positively related with environmental pollutants, PM2.5, O3 and CO levels. Additionally, with 1 µm increase in PM2.5 the number of cases and deaths significantly increased by 1.1% and 2.3% respectively. A 1 unit increase in CO level significantly increased the number of cases and deaths by 21.3% and 21.8% respectively. A similar trend was observed in O3, with 1-unit increase, the number of cases and deaths were significantly increased respectively by 0.8% and 4.4%. ConclusionsEnvironmental pollutants, PM2.5, CO and O3 have a positive association with an increased number of SARS-CoV-2 daily cases and daily deaths in London, UK. Environmental pollution management authorities must implement necessary policies and assist in planning to minimize the environmental pollution and COVID-19 pandemic.

Exploring the neighbourhood-level correlates of Covid-19 deaths in London using a difference across spatial boundaries method.

This paper explores neighbourhood-level correlates of the Covid-19 deaths in London during the initial rise and peak of the pandemic within the UK – the period March 1 to April 17, 2020. It asks whether the person-level predictors of Covid-19 that are identified in reports by Public Health England and by the Office of National Statistics also hold at a neighbourhood scale, remaining evident in the differences between neighbours. In examining this, the paper focuses on localised differences in the number of deaths, putting forward an innovative method of analysis that looks at the differences between places that share a border. Specifically, a difference across spatial boundaries method is employed to consider whether a higher number of deaths in one neighbourhood, when compared to its neighbours, is related to other differences between those contiguous locations. It is also used to map localised ‘hot spots’ and to look for spatial variation in the regression coefficients. The results are compared to those for a later period, April 18 – May 31. The findings show that despite some spatial diffusion of the disease, a greater number of deaths continues to be associated with Asian and Black ethnic groups, socio-economic disadvantage, very large households (likely indicative of residential overcrowding), and fewer from younger age groups. The analysis adds to the evidence showing that age, wealth/deprivation, and ethnicity are key risk factors associated with higher mortality rates from Covid-19.

What individual and neighbourhood-level factors increase the risk of heat-related mortality? A case-crossover study of over 185,000 deaths in London using high-resolution climate datasets

ObjectiveManagement of the natural and built environments can help reduce the health impacts of climate change. This is particularly relevant in large cities where urban heat island makes cities warmer than the surrounding areas. We investigate how urban vegetation, housing characteristics and socio-economic factors modify the association between heat exposure and mortality in a large urban area. MethodsWe linked 185,397 death records from the Greater London area during May-Sept 2007–2016 to a high resolution daily temperature dataset. We then applied conditional logistic regression within a case-crossover design to estimate the odds of death from heat exposure by individual (age, sex) and local area factors: land-use type, natural environment (vegetation index, tree cover, domestic garden), built environment (indoor temperature, housing type, lone occupancy) and socio-economic factors (deprivation, English language, level of employment and prevalence of ill-health). ResultsTemperatures were higher in neighbourhoods with lower levels of urban vegetation and with higher levels of income deprivation, social-rented housing, and non-native English speakers. Heat-related mortality increased with temperature increase (Odds Ratio (OR), 95% CI = 1.039, 1.036–1.043 per 1 °C temperature increase). Vegetation cover showed the greatest modification effect, for example the odds of heat-related mortality in quartiles with the highest and lowest tree cover were OR, 95%CI 1.033, 1.026–1.039 and 1.043, 1.037–1.050 respectively. None of the socio-economic variables were a significant modifier of heat-related mortality. ConclusionsWe demonstrate that urban vegetation can modify the mortality risk associated with heat exposure. These findings make an important contribution towards informing city-level climate change adaptation and mitigation policies.

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

BackgroundGamma-hydroxybutyrate (GHB) is the drug most linked to acute harm out of those used in chemsex, the incidence of which is reported to be increasing. However, there have been few systematic studies of the harms associated with GHB use. We investigated GHB-associated deaths from London coroners’ jurisdictions between 2011 and 2015. MethodsBlood and urine samples were collected by pathologists and submitted for toxicological analysis at the request of coroners. Data from the Toxicology Unit, Imperial College London was retrospectively analysed. This comprised of 6633 cases from seven out of eight coroners’ jurisdictions in London that underwent toxicological analysis between January 2011 and December 2015. ResultsA total of 61 GHB-associated deaths (0.92% of total cases), 184 cocaine-associated deaths (2.8% of total cases) and 83 MDMA-associated deaths (1.3% of total cases) were identified. There was a 119% increase in the proportion of GHB-associated deaths detected in 2015 compared to 2014. Over the same time period there was a 25% increase in cocaine-associated deaths and a 10% decrease in MDMA-associated deaths. ConclusionsOur data suggest that GHB-associated deaths are increasing in London, and that this is likely at least in part due to increasing use of GHB for chemsex. Further studies on the use of GHB are urgently required to understand the extent of its use, whether this is as prevalent in other major urban areas in the UK, and the full extent of the harms it causes.

Social and behavioural factors in Non-suspicious unexpected death in infancy; experience from metropolitan police project indigo investigation.

BackgroundRisk factors for Sudden Unexpected Death in Infancy (SUDI) are well described, and such cases are now investigated according to standard protocols. In London, Project Indigo of the Metropolitan Police provides a unique, detailed framework for such data collection. We investigate such data to provide a contemporary account of SUDI in a large city and further link data to publically available datasets to investigate interactions with social factors.MethodsRetrospective analysis of data routinely collected by the Metropolitan Police Service in all cases of non-suspicious SUDI deaths in London during a six year period.ResultsSUDI deaths are associated with markers of social deprivation in London. A significant proportion of such deaths are associated with potentially modifiable risk factors such as cigarette smoking and co-sleeping, such behaviour also being associated with social factors, including accommodation issues.ConclusionsRoutinely collected data provide valuable insight into patterns and associations of mortality, with SUDI remaining a significant issue in London. Risk factors include social disadvantage, which may manifest in part by affecting behavioural patterns such as co-sleeping and public health interventions to reduce rates require significant social modification.

Deaths of cyclists in London: trends from 1992 to 2006.

BackgroundCycling is an increasingly important mode of transport for environmental and health reasons. Cycling fatalities in London were previously investigated in 1994 using routinely collected data. Since then, there have been shifts in the modes of transport used, and in transport policies. We sought to replicate the previous work using data on cyclist deaths in London between 1992 and 2006, specifically investigating whether heavy goods vehicles continued to pose a threat.MethodsObservational study based on analysis of time series of police road casualties data, 1992 to 2006, in London, UK. The main outcome measures were cyclists killed in road traffic collisions. Poisson regression and chi-squared test for homogeneity were used to assess time effects. Travel flow data was then used to estimate annual fatality rates per 100,000 cyclists per kilometre.ResultsFrom 1992 to 2006 there was a mean of 16 cycling fatalities per year (range 8-21). 146 deaths (60%) were in inner London and 96 in outer London. There was no evidence for a decline over time (p = 0.7) other than a pronounced dip in 2004 when there were 8 fatalities. Freight vehicles were involved in 103 of 242 (43%) of all incidents and the vehicle was making a left turn in over half of these (53%). The fatality rate ranged from 20.5 deaths in 1992 to 11.1 deaths in 2006 per 100,000 estimated cyclists per kilometre (rate ratio 0.54, 95% confidence interval 0.28 to 1.03).ConclusionsThere is little evidence fatality rates have fallen. Freight vehicles over 3.5 tonnes continue to present a disproportionate threat; they should be removed from urban roads and more appropriate means of delivery of essential goods found.

The contribution of genital tract sepsis to maternal deaths in London

BackgroundGenital tract sepsis (GTS) caused 4% of maternal deaths in the UK in the last Confidential Enquiry into Maternal and Child Health (2003–2005) report. A large proportion of women in...

William Smellie and William Hunter: two great obstetricians and anatomists

William Smellie and William Hunter: two great obstetricians and anatomists

Diagnostic Spaces: Workhouse, Hospital, and Home in Mid-Victorian London

For nine weeks during the 1866 cholera epidemic, the registrar general for England and Wales published details of more than 13,000 deaths in London. Although the names of the deceased and the informant were withheld, all other information available from the death certificate was reproduced in the capital city's Weekly Returns , including registration district and subdistrict, precise address (house number and street, or institution), sex, age (sometimes down to hours for infants), occupation, cause(s) of death, and duration of final illness. Since historians' access to original death certificates in England and Wales is restricted, this source presents an opportunity to analyze systematically the practice of cause of death certification in the middle of the nineteenth century, albeit during a period of mortality crisis. Variability of diagnostic depth—that is, the listing of multiple causes and duration of final illness—is considered for three major causes: cholera, diarrhea, and respiratory tuberculosis. Deaths in workhouses and general hospitals were chronically underdocumented compared to home deaths. This finding supports the notion that the institutionalization of sickness in the nineteenth century was accompanied by a loss of the patient narrative and also points to the entrenchment of institutional cultures of record keeping and administration.

Renaissance Literature and Our Contemporary Attitude toward Global Warming

The manner by which industrial air pollution emerges as an issue of discussion in seventeenth-century England can—as unlikely as it may seem—tell us much about our present attitude toward the causes of global warming. In fact, as I hope to make clear in this essay, we risk misunderstanding these causes if we do not consider a troubling representational challenge faced by Renaissance writers, which, still with us today, may be distorting our understanding of the causes of our present environmental crisis. While human beings have been burning fossil fuels for thousands of years, early modern Londoners, having centuries before deforested the area surrounding their city, were almost exclusively burning a particularly dangerous form of highly sulfurous coal that created in both scope and type a problem that had not been encountered before. As seventeenth-century England was mining three to four times more coal than the rest of Europe combined, much of it burned in London, the scale of the problem was staggering.1 Even at the time, urban air pollution from coal was known to be responsible for the wholesale death of animals and fish (as acid rain deposited sulfur dioxide in waterways), the local extinction of entire species of plants, caustic erosion to buildings, and widespread respiratory disease, which was believed by the most celebrated statistician of the seventeenth century to be second only to the Plague as the leading cause of human deaths in London.

Diagnostic Spaces

For nine weeks during the 1866 cholera epidemic, the registrar general for England and Wales published details of more than 13,000 deaths in London. Although the names of the deceased and the informant were withheld, all other information available from the death certificate was reproduced in the capital city'sWeekly Returns, including registration district and subdistrict, precise address (house number and street, or institution), sex, age (sometimes down to hours for infants), occupation, cause(s) of death, and duration of final illness. Since historians’ access to original death certificates in England and Wales is restricted, this source presents an opportunity to analyze systematically the practice of cause of death certification in the middle of the nineteenth century, albeit during a period of mortality crisis. Variability of diagnostic “depth”—that is, the listing of multiple causes and duration of final illness—is considered for three major causes: cholera, diarrhea, and respiratory tuberculosis. Deaths in workhouses and general hospitals were chronically underdocumented compared to home deaths. This finding supports the notion that the institutionalization of sickness in the nineteenth century was accompanied by a loss of the “patient narrative” and also points to the entrenchment of institutional cultures of record keeping and administration.

Police deaths in New York and London during the twentieth century

Objectives: To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century....

ESTIMATING THE DISEASE PARAMETERS FOR SMALLPOX IN LONDON OVER THE PERIOD 1708 TO 1748

When predicting the spread of a disease such as smallpox, knowledge of the transmission parameter, R0, is important. Previous studies have estimated R0 from outbreaks of the disease, but these estimates are prone to uncertainties because of the small population sizes and the short data runs. This study uses data from smallpox deaths in London over the period 1708 to 1748. Although smallpox was endemic in the population at this time, by using an estimator based upon a second order Gaussian filter to fit a nonlinear model to the dynamics of the disease, the disease parameters are obtained, leading to an estimate of R0. The model also reveals the importance of temperature and rainfall on the transmissibility of the disease.

The spatial anatomy of an epidemic: influenza in London and the county boroughs of England and Wales, 1918–1919

From uncertain origins in the spring of 1918, an apparently new variant of influenza A virus spread around the world as three distinct diffusion waves, infecting half a billion and probably killing around 40 million people. This paper examines the spatial structure of influenza transmission during the ten–month course of the epidemic in England and Wales, June 1918–April 1919, using the weekly counts of influenza deaths in London and the county boroughs as collated by the General Register Office, London. In addition, a particular case study of the borough of Cambridge is presented. From mid–1916, Cambridge contained, as well as its undergraduate population, a large naval contingent billeted in both the colleges and the town. It therefore affords the opportunity of studying the effect of the epidemic in contiguous groups with widely differing demographic characteristics. Through the application of a range of statistical methods (average lags, correlations and regressions), it is shown that the three waves that comprised the pandemic had fundamentally different spatial and temporal characteristics. The first, moving through a population that was a virgin soil to the new virus strain, was explosive in its north to south progress across the country. The second wave was somewhat slower in its rate of diffusion and displayed a south to north drift. Finally, the third wave reverted more closely to the form of the first. The spread of all three waves, however, was underpinned by a clearly defined process of spatial contagion. The Cambridge study showed the special characteristics of this pandemic in terms of the ages of those attacked: high rates were experienced across the age spectrum, a feature also seen internationally.

Vaba, Haiza, Kholera, Foklune or Cholera: in any language still the disease of seven pandemics.

1. SUMMARY Cholera is a disease which can strike in any community where sanitary conditions deteriorate or where it is possible for a few people to transport the organism from infected areas to new communities. The historical background of the seven major pandemics and the discovery of the causative organism are provided from 1800 to 1995. With the procedure of oral rehydration therapy few patients should succumb to the disease if clean water is available. The problem is that large-scale floods in many places often lead to a breakdown in clean water supplies and sewerage treatment so it will not pay to be complacent, cholera has not disappeared!.

Resistance to antitubercular drugs.

Historians established the existence of endemic tuberculosis from Egyptian mummies dating from 2000 to 4000 B.C. (reviewed by Bloom and Murray, 1992). Tuberculosis was prevalent in Europe throughout the middle ages. Newly crowned kings of England and France were believed to have special healing powers and the most desired treatment of tuberculosis was being touched by these kings. Tuberculosis was responsible for 20% of all deaths in London in 1651, and the disease may have accounted for a third of all deaths in Paris in the 19th century. As Europeans colonized the Americas and sub-Saharan Africa, the disease was passed to susceptible populations and spread worldwide (Young et al 1996). In 1882, Robert Koch identified an acid-fast bacterium, Mycobacterium tuberculosis, as the causative agent of tuberculosis (Koch, 1932). His criteria for proof that the organism he discovered caused tuberculosis have been widely adopted and have become known as Koch’s postulates: isolation of the bacilli from the body, growth in pure culture, and reproduction of the same “morbid” condition by administering the isolated bacilli to animals. In 1908, the BCG (bacille Calmette-Guerin) vaccine was first used to immunize a patient, and is currently the most widely used vaccine in the world. Discovery of the antibacterial activity of prontosil in 1935 by Gerhard Domagk marked a fundamental change from pathogen-specific therapy to non-pathogen-specific therapy that allowed prompt and effective treatment of bacterial infections without the necessity of identifying the pathogens involved (Casadevall, 1996). The discovery of the antibacterial and antitubercular properties of streptomycin in 1944 (Schatz and Waksman), and both isoniazid and pyrazinamide in 1952 (Kushner et al.; Middlebrook), led to effective chemotherapies that decreased tuberculosis mortality rates in the United States and worldwide.

Cyclist road deaths in London 1985–1992: Drivers, vehicles, manoeuvres and injuries

We used coroners' records to investigate the fatal accidents of cyclists recorded on death certificates in London during 1985–1992. There were 124 deaths: 68 cyclists were injured in London and 56 injured in the “home counties” around London and died in London hospitals. The cyclists' ages were from 8–88, and 70% were male; the drivers were aged 17–74, and 96% were male. Of the 108 vehicles involved, 53 were cars (including one parked) and 40 heavy goods vehicles (HGVs) (including 14 large lorries and 18 articulated lorries), 5 light goods vehicles, 5 buses and coaches and 5 motorcycles. Fatal accidents occurred with a wide range of manoeuvres; of vehicles turning left (driving is on the left in the U.K.), 14 out of 15 were HGVs. Accidents were most often on 2 lane roads and one half were near a road junction. Law violations were recorded in half the accidents; alcohol intoxication contributed only rarely. While injuries to the head were the commonest reported direct cause of death, Inner London deaths were frequently due to multiple injuries. The study confirms the serious danger to cyclists (particularly women) in Inner London from large and articulated lorries, causing death from multiple injuries.

Micro- and Aggregate Perspectives on Life Table Heterogeneity: An Empirical Investigation of Area Mortality

This paper investigates the application of micro-level survival models to registered deaths in London and compares indices of mortality obtained with indices derived from aggregate life tables. Allowance for heterogeneity in mortality is made by parametric and non-parametric methods. A particular focus is on how far mortality differentials between different areas are explicable by the birthplace and social class of the deceased and on how far class or birthplace gradients may be understated by neglecting heterogeneity. Life expectancies are compared between heterogeneous and degenerate models, and no uniform effect is found toward a reduction in expectancy, either for micro- or for aggregate models. The data used come from registered deaths from 1988 to 1990 and from the OPCS Longitudinal Study for 1971-1985.