Seasonal Patterns Of Mortality Research Articles

Seasonality of deaths with respect to age and cause inChitral District Pakistan.

BackgroundSeasonal variability in mortality has been studied in various regions globally. Proper evaluation of seasonally fluctuating mortality is important to establish effective public health measures. We investigated the overall, age-specific, and cause-specific seasonality of deaths in Chitral District in Pakistan.MethodData on 2577 deaths were provided by the Agha Khan Health Support Program. Seasonal mortality patterns concerning age and causes were examined using the X-12 ARIMA pseudo-additive decomposition method.ResultsOf the total deceased, 59.6% were males. The proportion of deceased males was significantly higher than the female (40.4%, p< 0.001). The average age at death was 57.7 years (SD = 28.7). On average, approximately 43 deaths occurred each month. More than 10% of the deaths occurred in children less than 5-years-of-age. Among all the causes of death, the most frequent was cardiovascular disease (n = 666, 25.8%) followed by respiratory disease (n = 482, 18.7%). Significant seasonality in the overall deaths was evident, with a peak in winter. Deaths in people ≥ 55-years-of-age were significantly seasonal and peaked in winter. Deaths due to cardiovascular, respiratory, and kidney related diseases were also significantly seasonal with winter peaks. Further, deaths due to external causes were significantly seasonal with summer peak.ConclusionIn the winter season, all-cause, except external, and age-specific mortality peaks in Chitral District, Pakistan. Deaths due to external causes and cardiovascular, respiratory, and kidney related diseases were significant seasonal effects.

Comprehensive analysis of bird mortality along power distribution lines in Slovakia

Abstract Collisions and electrocutions on power lines are known to kill large numbers of birds annually on a global scale. We conducted comprehensive research focused on bird mortality caused by 22 kV and 110 kV distribution power lines in 13 Special Protection Areas in Slovakia. In the period between December 2014 and February 2016, 6,235 km of power lines were inspected twice during two periods (12/2014–03/2015 and 04/2015–02/2016) of field survey. In addition an intensive study was conducted during the second field survey at one-month intervals on power lines identified as the most dangerous for birds to collide with. As a result, 4,353 bird carcasses and bird remains representing 84 bird species and 14 orders were identified. Electrocution was suspected for 76.72% and collision for 23.28% of fatalities. Raptors were associated with 40% of all identified victims of electrocution. Two peaks of incidence were recorded, the first in March with a high rate of electrocutions as well as collisions of swans, pheasants, common blackbirds, ducks and herons, and the second in September predominantly featuring electrocution of raptors, magpies and corvids. We were unable to quantify seasonal patterns of mortality due to the limited sample of repeated mortality surveys resulting from the large grid of inspected power lines. We conducted comprehensive statistical analysis of more than 100 configurations of pylons and calculated their potential risk towards birds. Strong spatial correlation was revealed in the data set. Metal branch pylons and corner pylons with exposed jumper wires passing over the supporting insulators above the cross arms were the most dangerous configuration, accounting for 34.72% of total recorded electrocution fatalities (0.13 carcass/pylon). Cases of electrocution were also recorded for two bird species of major conservation concern in Slovakia: saker falcon (Falco cherrug) and eastern imperial eagle (Aquila heliaca). The results of this study may substantially improve conservation management and policies needed to reduce bird mortality.

Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case.

Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual's vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009-2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009-2012), Pre-Recession (2005-2008), and Post-Recession (2013-2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87years of life lost per 100,000 inhabitants in 2009-2012), life expectancy loss (1year in 2009-2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.

Season of birth, stillbirths, and neonatal mortality in Sweden: the Sami and non-Sami population, 1800–1899

ABSTRACT Seasonal patterns of neonatal mortality and stillbirths have been found around the world. However, little is known about the association between season of birth and infant mortality of pre-industrial societies in a subarctic environment. In this study, we compared how season of birth affected the neonatal and stillbirth risk among the Sami and non-Sami in Swedish Sápmi during the nineteenth century. Using digitised parish records from the Demographic Data Base at Umeå University, we applied logistic regression models for estimating the association of season of birth with stillbirths and neonatal mortality, respectively. Higher neonatal mortality was found among the winter- and autumn-born Sami, compared to summer-born infants. Stillbirth risk was higher during autumn compared to summer among the Sami, whereas we found no seasonal differences in mortality among the non-Sami population. We relate the higher neonatal mortality risk among winter-born Sami to differences in seasonality of living conditions associated with reindeer herding.

Climatic influences on the mortality of sheep during long-distance sea transport

Research on the causes of sheep death in sea voyages from Australia to the Middle East is limited, in particular little is known about the influence of climatic factors. Mortality data from 417 shipments of sheep exported over an 11-year period (November 2004 to June 2015) were modelled retrospectively to determine associated climatic factors. The statistical analysis were performed for both the full data set with 417 voyages based on actual and estimated departure and arrival dates and a restricted data set with 71 voyages based on actual dates. The results of the full data set demonstrated a seasonal mortality pattern, with more deaths occurring on sea voyages leaving Australia in the southern hemisphere winter or spring than those departing in Australian summer or autumn. Heat stress and inadequate fat mobilisation for energy supply when sheep are inappetant on shipments may explain this seasonality. Based on these two models, the voyage and weather factors associated with sheep mortalities included departure year, autumn departure in the southern hemisphere, voyage duration, single or multiple loading port(s), weekly mean dry bulb temperature and wind speed at departure ports, and humidity at destination ports. Significant correlations were observed between weather variables at the departure ports in the Australian winter and a high sheep mortality rate during voyages. This, together with the anticipated increased heat stress risk as a result of climate change, suggests that there could be review of the trade from Australia in the southern hemisphere winter. The influence of weather at the departure ports should be considered in sheep mortality prediction models, especially Australia’s heat stress risk assessment model.

Seasonal patterns of neurologic disease mortality in southern parts of Azerbaijan

Research objective: to estimate the dependence of mortality connected with neurologic diseases from season in the southern regions of the country with characteristic subtropical climate. Comparing mortal incidents on months and seasons within calendar year, in research the role of the seasonal factor was studied. Within each administrative region (Astara 518 and 199, Lerik 342 and 162, Lenkoran 1012 and 345, Masalli 1023 and 427, Yardymli 271 and 114) all mortal incidents, including the mortal incidents connected with neurologic diseases were analysed. It was established that seasonal character of death risk objectively exists and covers all mortal incidents happening for any reasons, and also connected with neurologic diseases. Regularity of increase of mortality risk was observed in spring and reduction - in autumn. In administrative regions in different months change of mortality risk was various. In winter, in summer and in autumn the mortality risk was in Astara at one level; whereas, in winter in Lenkoran and Yardymli, in autumn in Masalli and in summer in Lerik the mortality risk was at the lowest level.&#x0D; Seasonal character of mortality risk and its various properties on administrative regions can depend also on medico-organizing actions.

Hodgkin Lymphoma has a seasonal pattern of incidence and mortality that depends on latitude

Seasonal variations in incidence and mortality after a Hodgkin lymphoma (HL) diagnosis have been previously described with partly conflicting results. The goal of this analysis is to provide a comprehensive analysis of these seasonal variations. In total, 41,405 HL cases diagnosed between 1973 and 2012 in the 18 Surveillance, Epidemiology, and End Results registries were included. Cosinor analysis and Cox proportional-hazards models were employed to analyze seasonality of incidence and mortality, respectively. HL shows a sinusoid seasonal incidence pattern (p < 0.001). Estimated incidence in March is 15.4% [95%-CI: 10.8-20.0] higher than in September. This sinusoid pattern is more pronounced at higher latitudes (p = 0.023). The risk of dying within the first three years after a HL diagnosis in winter is significantly increased compared to a HL diagnosis in summer at higher latitudes (HR = 1.082 [95%-CI: 1.009-1.161], p = 0.027). Furthermore, increasing northern latitude increases the additional mortality risk conferred by a diagnosis in winter (pinteraction0.033). The seasonality patterns presented here provide epidemiological evidence that Vitamin D might play a protective role in HL. Further evidence on the direct association between Vitamin D levels and the clinical course of HL needs to be collected to advance the understanding of the role of Vitamin D in HL.

Cerebrovascular diseases in Poland-inconsistent seasonal patterns of hospitalisation and mortality.

A seasonal variation in the incidence of cerebrovascular diseases still remains inconsistently evidenced. Herein, we analyse the monthly patterns of two health phenomena: hospital admissions and deaths due to these diseases. We identified 69 511 cases of hospital admissions and 14 956 deaths due to cerebrovascular diseases (ICD10: I60-I69 and G45) among the inhabitants of five Polish voivodeship capitals in 2004-13. The method of time series analysis (exponential smoothing with linear trend and monthly additive seasonality) was applied to calculate the monthly specific seasonal indices. The monthly variation in an in-hospital fatality and nonhospital deaths were also analysed. A summer season reduction in number of cases was observed for hospital admissions and deaths. Interestingly, the winter season effect is much more complex, mainly due to the contribution of December, when a high mortality is accompanied by a substantial decrease in the hospitalisation level. This unique discrepancy was observed for all the studied cities. Moreover, this month is characterised by a notably high in-hospital fatality. However, neither the number of non-hospital deaths nor the average length of hospital stay or the kind of hospitalised diseases evidenced that cerebrovascular problems were more serious in December than in any other month. The obtained results confirmed a seasonal variation in cerebrovascular diseases among the inhabitants of Polish cities. Habitual and administrative limitations in hospital activities observed every December do not seem indifferent from the patient health's perspective since they may lead to a low hospitalisation level and a high in-hospital fatality.

Effects of rangeland management on survival of female greater prairie‐chickens

ABSTRACTIdentifying relationships between habitat selection and population processes is important for habitat management and wildlife conservation. For prairie‐obligate species, space use and demography in extant grasslands are influenced by habitat conditions caused by rangeland management practices associated with livestock production. Greater prairie‐chickens (Tympanuchus cupido) are an indicator species for native tallgrass prairie ecosystems, but populations have declined in the Flint Hills ecoregion of eastern Kansas, USA because of intensification of rangeland management practices, including annual prescribed fire and high stocking densities. Patch‐burn grazing is a rotational system that provides heterogeneous habitats and can improve productivity of grassland birds, but the effects of grazing systems on habitat use or survival of greater prairie‐chickens are unknown. We used 3 types of survival analyses to investigate impacts of rangeland management on female greater prairie‐chickens in the central Flint Hills during 2011–2013: Kaplan–Meier models and Cox proportional hazards to examine factors affecting annual survival rates, hazard functions to assess seasonal patterns of mortality, and Andersen–Gill models to explore the links between habitat selection and cause‐specific mortality risk. Females captured at properties managed with patch‐burn grazing had annual survival rates (0.61 ± 0.07 SE) that were 35% higher than females on properties managed with annual burning and intensive early cattle stocking (0.45 ± 0.06). Moreover, females that selected habitats associated with intensive management had increased mortality risk and were particularly vulnerable to avian predators, whereas females that selected habitats created by patch‐burn grazing experienced lower overall mortality risk but were more vulnerable to mammalian predators. Overall mortality risk was significantly reduced under patch‐burn grazing management, and widespread implementation of annual spring burning and intensive early stocking is likely depressing survival of greater prairie‐chickens in the Flint Hills ecoregion. Our results join a growing body of evidence that patch‐burn grazing can provide higher quality grassland habitats for native wildlife species than current rangeland management associated with intensive cattle production. © 2017 The Wildlife Society

Human predatory behavior and the social implications of communal hunting based on evidence from the TD10.2 bison bone bed at Gran Dolina (Atapuerca, Spain)

Zooarcheological research is an important tool in reconstructing subsistence, as well as for inferring relevant aspects regarding social behavior in the past. The organization of hunting parties, forms of predation (number and rate of animals slaughtered), and the technology used (tactics and tools) must be taken into account in the identification and classification of hunting methods in prehistory. The archeological recognition of communal hunting reflects an interest in evolutionary terms and their inherent implications for anticipatory capacities, social complexity, and the development of cognitive tools, such as articulated language. Late and Middle Paleolithic faunal assemblages in Europe have produced convincing evidence of communal hunting of large ungulates allowing for the formation of hypotheses concerning the skills of Neanderthals anatomically modern humans as social predators. However, the emergence of this cooperative behavior is not currently understood. Here, faunal analysis, based on traditional/long-established zooarcheological methods, of nearly 25,000 faunal remains from the “bison bone bed” layer of the TD10.2 sub-unit at Gran Dolina, Atapuerca (Spain) is presented. In addition, other datasets related to the archeo-stratigraphy, paleo-landscape, paleo-environmental proxies, lithic assemblage, and ethno-archeological information of communal hunting have been considered in order to adopt a holistic approach to an investigation of the subsistence strategies developed during deposition of the archeological remains.The results indicate a monospecific assemblage heavily dominated by axial bison elements. The abundance of anthropogenic modifications and the anatomical profile are in concordance with early primary access to carcasses and the development of systematic butchering focused on the exploitation of meat and fat for transportation of high-yield elements to somewhere out of the cave. Together with a catastrophic and seasonal mortality pattern, the results indicate the procurement of bison by communal hunting as early as circa 400 kyr. This suggests that the cognitive, social, and technological capabilities required for successful communal hunting were at least fully developed among the pre-Neanderthal paleodeme of Atapuerca during the Lower Paleolithic. Similarly, the early existence of mass communal hunting as a predation technique informs our understanding of the early emergence of predatory skills similar to those exhibited by modern communal hunters. ResumenLa zooarqueología es una importante herramienta para la reconstrucción de la subsistencia y también para inferir aspectos relevantes del comportamiento social en el pasado. En este trabajo presentamos el análisis faunístico del llamado “lecho de huesos de bisonte”, contenido en la subunidad TD10.2 del yacimiento Gran Dolina (Atapuerca, España). La composición taxonómica y perfil anatómico indican un conjunto monoespecífico fuertemente dominado por elementos del esqueleto axial de bisonte (Bison sp.). Las características y abundancia de las modificaciones antrópicas revelan un acceso primario e inmediato a las carcasas, así como el desarrollo de un procesado carnicero sistemático dirigido a la explotación de la carne y grasa, y a la preparación para el transporte de elementos de alto rendimiento hacia algún lugar fuera de la cavidad. Esas características unidas a un perfil de mortalidad catastrófico y estacional, sugieren la obtención de los bisontes mediante caza comunal. La frecuencia, localización e intensidad de las mordeduras de carnívoro en los restos indica un fuerte saqueo de las carcasas de bisonte una vez abandonadas éstas por los homininos en el yacimiento. La suma de decisiones antrópicas sobre el transporte y el posterior saqueo por carnívoros de los despojos abandonados resulta en un conjunto interpretado como lugar de matanza y procesamiento carnicero de bisontes carroñeados posteriormente por las fieras. Las analogías etnográficas, etnohistóricas y arqueológicas nos han permitido interpretar el “lecho de huesos de bisonte” como cazadero utilizado durante varios eventos estacionales de caza comunal en los que rebaños completos de bisontes fueron sacrificados para ser explotados intensamente por los homininos que ocuparon la cueva. El repetido uso estacional de un punto en el territorio para el desarrollo de tareas específicas muestra ciertas similitudes con el patrón logístico de gestión de los recursos. En el mismo sentido, la existencia temprana de la caza comunal como táctica depredatoria nos informa sobre la emergencia de habilidades cognitivas, tecnológicas y sociales similares a aquellas exhibidas por otros cazadores comunales modernos en un momento tan temprano como el Pleistoceno medio.

Seasonal Differences in Incidence and Survival of Hodgkin Lymphoma Depend on Geographic Location of Diagnosis

It has been previously described that Hodgkin lymphoma (HL) exhibits a seasonal incidence and mortality pattern. However, these findings arise from small datasets and are partially conflicting. The aim of the present study is to provide the most comprehensive analysis of seasonal variation in incidence and mortality risk of HL with a focus on geographic differences in a very large, high-quality dataset.All HL cases diagnosed between 1973 and 2012 in the 18 Surveillance, Epidemiology and End Results (SEER) registries were eligible (n=50,179). We excluded all death certificate and autopsy only cases (n=281), cases with unknown month of diagnosis (n=257), the "Alaska natives" (n=17) and "Rural Georgia" (n=57) registries due to low case numbers and cases with missing information on age at diagnosis (n=5) and Ann-arbor stage (n=8157), resulting in 41,405 cases being included in the study. All cases were grouped into quartiles according to the latitude of the case’s county (Quartile 1: <34.19°N; Quartile 2: 34.19°N to 38.05°N; Quartile 3: 38.05°N to 41.68°N; Quartile 4: ≥41.68°N). The monthly incidence was adjusted for length of month. Cosinor analysis was employed to examine seasonality of incidence in all cases, latitude quartiles and other preplanned subgroups, such as gender, histological subtype, Ann-arbor stage and decade of diagnosis. The overall mortality risk within 3 years following HL diagnosis was analyzed using a Cox proportional-hazards model with a dichotomized variable representing season of diagnosis (Winter: Sept.-Feb., Summer: Mar.-Aug.). Known risk factors were corrected for.HL exhibits a highly significant (p<0.001) seasonal incidence pattern with a peak in March and a trough in September. The adjusted incidence in September is approximately 15% higher than in March. This pattern was equally present in males (p<0.001) and females (p<0.001), but only present in the mixed cellularity (p<0.001), nodular sclerosis (p<0.001) and lymphocyte depleted subtypes (p=0.002). Seasonality was particularly pronounced in the age groups 20-29, 30-39 and 60-69, coinciding with age groups of increased HL incidence. All latitude quartiles showed significant seasonality patterns when analyzed separately, but the pattern was more pronounced in the two northern (≥38.05°N) quartiles with an amplitude of 0.102 ([0.073; 0.131], p<0.001) compared to the two southern (<38.05°N) quartiles with an amplitude of 0.055 ([0.026; 0.084], p<0.001). The difference was statistically significant (p=0.023).Considering all cases, a diagnosis in winter does not significantly increase the risk of dying compared to being diagnosed in summer (HR=1.030 [0.981; 1.081], p=0.234). However, looking at cases diagnosed in the two northern (≥38.05°N) quartiles showed an increased risk of death within 3 years after HL diagnosis (HR=1.082 [1.009; 1.161], p=0.027), whereas no such relationship was evident for cases diagnosed in the two southern (<38.05°N) latitude quartiles (HR=0.990 [0.926; 1.059], p=0.772). To further examine the relationship between latitude and excessive mortality risk after a diagnosis made in winter, we included a multiplicative interaction term between the dichotomous season of diagnosis variable and latitude. The hazard ratio for the interaction term was 1.119 ([1.009; 1.241], p=0.033) indicating a significant interaction in the way that mortality risk after a HL diagnosis in winter compared to summer is only increased at higher latitudes. All results were confirmed using 5 years of follow-up data.To conclude, HL exhibits a seasonal incidence and mortality pattern in this study, the most comprehensive analysis on this topic performed to date. The seasonal effect on the incidence of HL is exacerbated and the seasonal effect on mortality risk is only present at higher latitudes. Increased seasonal variations in Vitamin D levels at higher latitudes have been previously described. Therefore, a twofold protective effect of Vitamin D, where it both prevents HL development and increases the chance of survival after a diagnosis of HL is a possible explanation. Further studies, particularly those directly measuring Vitamin D levels in HL patients, are needed to improve the understanding of the role of Vitamin D in HL. DisclosuresEngert:Takeda, BMS: Consultancy, Honoraria, Research Funding.

Seasonality of stroke in Finland

Introduction: The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent.Methods: A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004–2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH).Results: The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality.Conclusions: All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades.Key messagesAll major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer.Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype.The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982–1992.

Seasonal Mortality and Movement Patterns of White Bass in a Southeastern U.S. Reservoir

AbstractLittle is known about the fundamental aspects of the life history, ecology, and population dynamics of White Bass Morone chrysops in southern U.S. reservoirs, making management of this species difficult. Recent concerns from the North Carolina Wildlife Resources Commission regarding potential population declines in North Carolina prompted an effort to expand the knowledge base of White Bass in reservoirs. Our study aimed to address mortality (fishing mortality, F, and natural mortality, M) as one potential mechanism related to their population declines and to assess seasonal movement and habitat patterns of reservoir White Bass throughout the year using telemetry. We implanted acoustic transmitters into 50 White Bass in spring 2012 and into 25 White Bass in spring 2013. B. Everett Jordan Reservoir, a relatively shallow and eutrophic reservoir located in the Piedmont region of North Carolina, was separated into four different subbasins that were surveyed each month for tagged fish. Fish were monitored using an array of passive receivers and monthly active tracking surveys. A monthly capture history was used as the input for a multistate capture–recapture model in a Bayesian framework to estimate instantaneous monthly mortality rates. Total annual mortality was 76%. The annual exploitation rate (60%) was greater than the natural mortality rate (15%); however, both F and M exhibited seasonal variation and peaked during spring months in 2012 and 2013. White Bass did not use any specific habitat type but were located relatively far from shore and in deep water during cooler months. The use of subbasins in the system was not equal; other than during the spawning run White Bass concentrated in several areas within the two deepest subbasins of the reservoir. Overall, the high F observed in the spring suggests that adjusting the current liberal harvest limits will help mitigate mortality and aid in the management of reservoir White Bass populations.Received January 21, 2016; accepted May 4, 2016 Published online August 5, 2016

Seasonal mortality patterns and regional contrasts in Portugal

Abstract The main aim of this study is to identify the geographical seasonal mortality patterns in Portugal and, for the first time, to assess the relationship between seasonal and overall mortality. Monthly data from the Portuguese mortality database (2000-2009) by major cause of death were analysed and standardized to 30 days with adjustments for leap years. The chi-square goodness-of-fit test was used to compare the observed monthly deaths with deaths that could be expected if mortality were randomly distributed throughout the year. The seasonal burden was measured using the excess winter deaths (EWD) rate and the seasonal impact of winter on mortality was assessed through the EWD Index. The regions were clustered according to the overall mortality rate and the seasonal impact: 1-low seasonality and high values of overall mortality; 2-high seasonality and high values of overall mortality; 3-low values of seasonality and low overall mortality; 4-high seasonality and low overall mortality. Significant seasonal mortality increases were found in all causes of death. There were 86,000 EWDs, mostly through circulatory and respiratory diseases. 73% of the population lives in regions with high winter vulnerability to respiratory mortality and 60% in regions with high winter vulnerability to circulatory mortality. This study reinforces the idea that vulnerability to cold weather may play an important role in the public health in Portugal. This knowledge may be used to construct a set of regulations or policies designed to implement better health planning procedures and more effective warning systems.

Season of bison mortality in TD10.2 bone bed at Gran Dolina site (Atapuerca): Integrating tooth eruption, wear, and microwear methods

The middle Pleistocene assemblage of Gran Dolina TD10.2 bone bed level (Atapuerca, Spain) is composed primarily by bison remains (Bison sp.) belonging to a minimal number of individuals of 60. The mortality and taphonomical features suggest an anthropogenic origin product of mass predation. The large number of mandibles and mandibular teeth of a single species has allowed us to explore the nature of kill events and seasonality of occupations through two methods: eruption and wear-pattern and tooth microwear. Here we combine data obtained on young individuals from tooth eruption and wear and on prime and old adults from tooth microwear. Integrating the results from the two independent and non-destructive methods permits to combine data from the entire population found in the assemblage increasing the sample size. This approach permits to evaluate the seasonality to confirm if the seasonal pattern is similar in young and adults. The integration of the two methods has allowed the identification of two main periods of occupation rejecting a single kill scenario but also permitting to observe phases with low number of individuals which certainly correspond to moments of the year when the site was not occupied. Tooth wear and eruption patterns moreover permit to establish the time of the year when the principal events occurred — one in late spring/early summer and other in early fall. The preliminary results indicate a seasonal mortality pattern on TD10.2 bone bed bison population and a seasonal use of the Gran Dolina site for anthropogenic occupations.

Excess winter mortality associated with Alzheimer’s Disease and related dementias in the UK: A case for energy justice

For more than 25 years, excess winter deaths (EWDs) have been associated with adverse respiratory and cardiovascular events. More recently, an association between EWDs and a new spectrum of morbidity has been noted by the Office for National Statistics (ONS) for England and Wales: since at least 2009, a high prevalence of excess winter mortality has also been evident among people living with Alzheimer’s Disease and related dementias (ADRD). In the present study, excess winter mortality data for all of the UK (England, Wales, Scotland and Northern Ireland) are analysed, using a longer time series (22 years). Results corroborate ONS findings related to elevated risk of death during winter for people living with ADRD. Seasonal effects have been sustained throughout the 22 year period, and people with ADRD emerge as being at greater risk of a winter death than people with cardiovascular conditions. Establishing the reasons for such pronounced seasonal mortality patterns among people with ADRD could help ensure better energy justice for people living with the severe mental impairments imposed by these conditions, guiding more effective delivery of energy efficiency and health services to people living with this increasingly prevalent disease spectrum.

Seasonal and temporal trends in all-cause and malaria mortality in rural Burkina Faso, 1998-2007.

BackgroundHigh mortality levels in sub-Saharan Africa are still a major public health problem. Children are the most affected group with malaria as one of the major causes of death in this region. To plan health interventions, reliable empirical information on cause-specific mortality patterns is essential, yet such data are often not available in developing countries. Health and Demographic Surveillance Systems (HDSS) implementing the verbal autopsy (VA) method provide such data on a longitudinal basis. Physician Coded VA is usually used to determine cause of death, but recently a computerized method, Interpreting VA (InterVA) was alternatively introduced. This study investigates the effect of season on all-cause and malaria mortality analysing cause of death data from 1998 to 2007 obtained by the Nouna HDSS in rural Burkina Faso and derived by InterVA.MethodsMonthly mortality rates were calculated for different age groups (infants, children, adolescents, adults, elderly). Seasonal and temporal trends were modelled with parametric Poisson regression adjusted for sex, area of residence and year of death.ResultsOverall, 7,378 deaths occurred corresponding to a mortality rate of 11.9/1,000 with highest rates in infants (56.8/1,000) and children (22.0/1,000). Young children were most affected by malaria. Malaria mortality patterns in children showed significantly higher rates during the rainy season and a stagnant long-term trend. The seasonal trend is well described parametrically with a sinusoidal function. InterVA assigned about half as many deaths to malaria than physicians.ConclusionsMalaria mortality remains highly seasonal in rural Burkina Faso. The InterVA method appears to determine reasonably well seasonal mortality patterns, which should be considered for the planning of health resources and activities.

Living standards and plague in London, 1560–1665

This article uses individual records of 930,000 burials and 630,000 baptisms to reconstruct the spatial and temporal patterns of birth and death in London from 1560 to 1665, a period dominated by recurrent plague. The plagues of 1563, 1603, 1625, and 1665 appear of roughly equal magnitude, with deaths running at five to six times their usual rate, but the impact on wealthier central parishes falls markedly through time. Tracking the weekly spread of plague, we find no evidence that plague emerged first in the docks, and in many cases elevated mortality emerges first in the poor northern suburbs. Looking at the seasonal pattern of mortality, we find that the characteristic autumn spike associated with plague continued into the early 1700s. Natural increase improved as smaller crises disappeared after 1590, but fewer than half of those born survived childhood.

Abstract 61: Seasonal Variation of In-Hospital Mortality in Patients with Acute Ischemic Stroke

Background and objectives: Seasonal patterns in incidence and mortality are well known for cardiovascular diseases (CVD) including acute myocardial infarction and arrhythmias. It is unclear whether in-hospital mortality in patients with acute ischemic stroke (AIS) exhibits seasonal variation. Methods: We searched the 2011 Nationwide Inpatient Sample for discharges with a principal diagnosis of AIS using the ICD-9 codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1. Seasonal variation in in-hospital mortality was tested using logistic regression with admission season and month as categorical predictors in separate models. In addition to annual variation, we tested for the “July effect” of increase in mortality in teaching hospitals. Results: There was an estimated 467, 849 discharges for AIS of which 21,149 (4.53%) died in the hospital. Compared to summer months, the risk of in-hospital mortality was 12.6% higher in winter and 10.2% higher in the fall (p=0.004 for winter vs. summer, p=0.024 for fall vs. summer). Compared to August, mortality was 18.20% higher in January (p=0.026 for comparison) and 24.3% higher in December (p=0.003 for comparison) (Table shows odds ratio of death compared to reference season/month). We did not find any evidence of a “July effect” of increased mortality, often attributed to new trainees, in teaching hospitals (p=0.830 for June vs. July) Conclusions: In a large national database of hospital discharges related to AIS, mortality was significantly higher in colder months compared to warmer months. Our study adds to the growing body of evidence that links winter season to worse outcomes in CVD.

Unusually cold and dry winters increase mortality in Australia

Seasonal patterns in mortality have been recognised for decades, with a marked excess of deaths in winter, yet our understanding of the causes of this phenomenon is not yet complete. Research has shown that low and high temperatures are associated with increased mortality independently of season; however, the impact of unseasonal weather on mortality has been less studied. In this study, we aimed to determine if unseasonal patterns in weather were associated with unseasonal patterns in mortality. We obtained daily temperature, humidity and mortality data from 1988 to 2009 for five major Australian cities with a range of climates. We split the seasonal patterns in temperature, humidity and mortality into their stationary and non-stationary parts. A stationary seasonal pattern is consistent from year-to-year, and a non-stationary pattern varies from year-to-year. We used Poisson regression to investigate associations between unseasonal weather and an unusual number of deaths. We found that deaths rates in Australia were 20–30% higher in winter than summer. The seasonal pattern of mortality was non-stationary, with much larger peaks in some winters. Winters that were colder or drier than a typical winter had significantly increased death risks in most cities. Conversely summers that were warmer or more humid than average showed no increase in death risks. Better understanding the occurrence and cause of seasonal variations in mortality will help with disease prevention and save lives.