Winter Deaths Research Articles

Risk of winter hospitalisation and death from acute respiratory infections in Scotland: national retrospective cohort study.

We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland. A population-based retrospective cohort analysis. Scotland. The study involved 5.4 million residents in Scotland. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation. Between 1 September 2022 and 31 January 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1759 in children and 20,525 in adults) in Scotland. Compared with the reference group of children aged 6-17 years, the risk of ARI hospitalisation was higher in children aged 3-5 years (aHR = 4.55; 95% CI: 4.11-5.04). Compared with those aged 25-29 years, the risk of ARI hospitalisation was highest among the oldest adults aged ≥80 years (aHR = 7.86; 95% CI: 7.06-8.76). Adults from more deprived areas (most deprived vs. least deprived, aHR = 1.64; 95% CI: 1.57-1.72), with existing health conditions (≥5 vs. 0 health conditions, aHR = 4.84; 95% CI: 4.53-5.18) or with history of all-cause emergency admissions (≥6 vs. 0 previous emergency admissions, aHR = 7.53; 95% CI: 5.48-10.35) were at a higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children. Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.

Excess winter mortality in Finland, 1971–2019: a register-based study on long-term trends and effect modification by sociodemographic characteristics and pre-existing health conditions

ObjectivesExcess winter mortality is a well-established phenomenon across the developed world. However, whether individual-level factors increase vulnerability to the effects of winter remains inadequately examined. Our aim was to assess...

The rise and fall of excess winter mortality in New Zealand from 1876 to 2020

Excess winter mortality (EWM) has been used as a measure of how well populations and policy moderate the health effects of cold weather. We aimed to investigate long-term changes in the EWM of Aotearoa New Zealand (NZ), and potential drivers of change, and to test for structural breaks in trends. We calculated NZ EWM indices from 1876 (4,698 deaths) to 2020 (33,310 deaths), total and by age-group and sex, comparing deaths from June to September (the coldest months) to deaths from February to May and October to January. The mean age and sex-standardised EWM Index (EWMI) for the full study period, excluding 1918, was 1.22. However, mean EWMI increased from 1.20 for 1886 to 1917, to 1.34 for the 1920s, then reduced over time to 1.14 in the 2010s, with excess winter deaths averaging 4.5% of annual deaths (1,450 deaths per year) in the 2010s, compared to 7.9% in the 1920s. Children under 5 years transitioned from a summer to winter excess between 1886 and 1911. Otherwise, the EWMI age-distribution was J-shaped in all time periods. Structural break testing showed the 1918 influenza pandemic strain had a significant impact on trends in winter and non-winter mortality and winter excess for subsequent decades. It was not possible to attribute the post-1918 reduction in EWM to any single factor among improved living standards, reduced severe respiratory infections, or climate change.

Impacts of climate change and environmental pollution: a public health foresight study

Abstract Background In the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. A priority topic in the PHF2024 is climate change and living environment. The important transitions (energy, food, mobility, housing) that are required all require space and thus pose a societal challenge for the future quality of the living environment. Approach We use a mixed method approach to identify main trends and impacts on public health: - analysis of Demographic, Economic, Socio-cultural, Technological, Ecological and Political developments (DESTEP) based on a literature review and expert consultation; -organization of focus group discussions with young people (N = 41); -analysis of mortality data in relation to temperature; -evaluation of trend-scenarios. Results Direct and indirect health impacts of climate change will become more visible in the next 30 years. These need not all be negative. For example, an earlier edition of the PHF already showed that the increase in temperature may lead to less deaths in winter but more deaths in summer. In the PHF we will focus not only on adverse health consequences, but also identify opportunities for health improvement through climate mitigation and adaptation. Similarly we will look into related developments like energy and mobility transitions, that may (partly) result in health gains, depending on how they will be implemented and who will be affected. For example, we will look into possible improvement of air quality and its impact on health. The preliminary findings of our focus group study suggest, however, that young people are mostly pessimistic regarding developments in our living environment. This is particularly the case for climate change; young people fear that this may cause severe events. Nevertheless, they have high expectations regarding technological advancement in the energy sector. Key messages • Foresight studies should not focus on risk alone but also identify possible health promoting developments in the living environment. • Expert views and views of lay people, in particular youth, may not necessarily be identical. Both need to be addressed in foresight studies.

Simple solutions for improving thermal comfort in huts in the highlands of Peru

In the Peruvian mountains, hundreds of thousands of rural households living in poverty live in cold indoor environments, close to 0 °C. Indoor cold causes thousands of respiratory diseases and excess of winter deaths. In this study, we numerically calculated the impact of simple low-cost refurbishments on discomfort time during a year.Using EnergyPlus and Python, we modelled a typical one-room hut used as bedroom built with a metal-sheet roof, adobe walls, dirt floors, and high infiltration rates. Then, 9 individual solutions were studied, and their combination resulted in 215 different hut designs. The model was calibrated with field measurements to estimate the infiltration. All the numerical calculations included an uncertainty analysis based on Monte Carlo method, and a sensitivity analysis to assess the impact of reducing infiltration on discomfort time.The base case had a discomfort time of 44% of time. The calibration of infiltration resulted in a mean hourly air exchange rate equal to 29.1 h−1 (SD = 17.0 h−1). Five different designs formed the Pareto front that optimized discomfort time and costs. The solution with the lowest discomfort time during a year, 37% of the time, was adding insulation to the roof (U = 0.83 W/m2•K) and the door (U = 1.00 W/m2•K); and its cost was 286USD. In this solution, when infiltrations were reduced to 4.1 h−1 (SD = 4.1 h−1) discomfort time decreased until 16%.These results benefit those households that nowadays invest their limited resources to improve their living conditions but without technical guidance.

Policy prescriptions to address energy and transport poverty in the United Kingdom

Tens of millions of households across Europe struggle to afford adequate electricity and heating services and reliable transportation, while recent high fuel prices could lead to an increase in excess winter deaths. Tackling energy and transport poverty is thus of paramount policy importance. Here we document the drivers and lived experiences of energy and transport poverty in the United Kingdom, based on public focus groups and expert interviews. We find a set of policies that resonate with both expert planners and members of the public, implying they have a level of political and social acceptability that other measures may be lacking, notably: mandatory landlord energy efficiency upgrades, increasing the extent of financial assistance to households, cheaper (or even free) bus and train fares and restarting and expanding bus services. We buttress these findings with further suggestions for energy and transport system redesign that better meets emerging principles of energy and social justice.

Seasonality of Sintashta Funerary Rites (Based on the Kamennyi Ambar-5 Bronze Age Cemetery)

Based on archaeological materials from the Kamennyi Ambar-5 cemetery, we test the hypothesis about the connection between the seasonality of pastoral practices and funerary rites during the Late Bronze Age (early 2nd millennium BC). We studied growth layers in the teeth of 24 cows, 19 sheep/goats, 14 horses, a dog, and ten humans from 17 graves. We combined samples from various species from the same contexts into eight assemblages. With regard to animals, differences in seasons of death were revealed only once. 70 % of graves were arranged in spring and 30 % in autumn. Therefore, the hypothesis about the seasonal use of the cemetery can be supported at least partially. The contemporaneous settlement of Kamennyi Ambar demonstrates a similar tendency in the seasonality of animal slaughtering. However, the reasons for slaughtering at the settlement differed from those in the cemetery. At the settlement site, it was motivated by practical needs, and in themortuary site, only by the seasonality of human deaths, specifically Ьy a higher frequency of deaths in late winter and spring. Also, postmortem selection is possiЬle, whereЬy kurgan burials were arranged only for some individuals. In practice, several of the above factors overlapped, resulting in an anomalous composition of the buried cohort (disproportion of sexes and a higher proportion of individuals who died at the peak of vital activity).

Inverse Association of Skin Temperature With Ambulatory Blood Pressure and the Mediation of Skin Temperature in Blood Pressure Responses to Ambient Temperature.

The inverse association between ambient temperature and blood pressure (BP) has been investigated in the context of excess cardiovascular mortality in winter. However, the role of skin temperature (ST), which reflects our external and internal thermal environments, in BP regulation remains unclear. Therefore, we examined the association between ST and ambulatory BP and the mediation of ST in BP responses to ambient temperature in real-life settings. We conducted a longitudinal analysis using repeated measurements of ambulatory BP and ST for 48 hours (30 711 daytime readings and 17 382 nighttime readings) among 584 older adults between October and March (2012-2014). Linear mixed-effect models were used to examine the association of distal (mean of wrist and ankle) and proximal (abdomen) ST with systolic BP. The mediation of ST in BP responses to ambient temperature was examined using path analysis. Distal and proximal STs were significantly associated with systolic BP during the daytime (regression coefficients: -4.27 mm Hg [95% CI, -4.58 to -3.96] and -2.74 mm Hg [95% CI, -3.14 to -2.56] per SD of ST, respectively), independent of potential confounders. The significant associations also existed during nighttime. The mediation effect of distal ST was 7.1 times higher than that of proximal ST during daytime, while those of distal and proximal STs during nighttime were almost identical. ST, especially in distal regions, was inversely associated with ambulatory BP. Our results have the potential for application to interventional studies targeting ST regulation to reduce excess cardiovascular deaths in winter.

Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends.

Trends in excess winter mortality (EWM) were investigated from the winter of 1900/01 to 2019/20. During the 1918–1919 Spanish flu epidemic a maximum EWM of 100% was observed in both Denmark and the USA, and 131% in Sweden. During the Spanish flu epidemic in the USA 70% of excess winter deaths were coded to influenza. EWM steadily declined from the Spanish flu peak to a minimum around the 1960s to 1980s. This decline was accompanied by a shift in deaths away from the winter and spring, and the EWM calculation shifted from a maximum around April to June in the early 1900s to around March since the late 1960s. EWM has a good correlation with the number of estimated influenza deaths, but in this context influenza pandemics after the Spanish flu only had an EWM equivalent to that for seasonal influenza. This was confirmed for a large sample of world countries for the three pandemics occurring after 1960. Using data from 1980 onward the effect of influenza vaccination on EWM were examined using a large international dataset. No effect of increasing influenza vaccination could be discerned; however, there are multiple competing forces influencing EWM which will obscure any underlying trend, e.g., increasing age at death, multimorbidity, dementia, polypharmacy, diabetes, and obesity—all of which either interfere with vaccine effectiveness or are risk factors for influenza death. After adjusting the trend in EWM in the USA influenza vaccination can be seen to be masking higher winter deaths among a high morbidity US population. Adjusting for the effect of increasing obesity counteracted some of the observed increase in EWM seen in the USA. Winter deaths are clearly the outcome of a complex system of competing long-term trends.

Seasonal Variation Analysis for Weekly Cases, Deaths, and Hospitalizations of COVID-19 in the United States.

Knowing the seasonality of COVID-19 helps decision-makers to take suitable interventions against the pandemic. In this study, we performed the Brown-Forsythe variance analysis on seasonal variations on different indicators based on the data on COVID-19 for the United States provided publicly by WHO. Our study finds that the seasonality of weekly cases and deaths of COVID-19 are strongly statistically supported by the data. The weekly total cases(/deaths) in winter are three to seven times(/two to three times) more than the other three single seasons. The ICU patients in winter and autumn are four to five times more than spring. The weekly hospital admissions in winter are four times more than spring. The mean of the positive rate in winter is five times more than spring. The findings of this research can be a reference in decision-making when taking interventions against the pandemic, such as taking stricter interventions in winter while considering less strict interventions in summer, etc.

Increased ratio of summer to winter deaths due to climate warming in Australia, 1968–2018

ObjectiveTo determine if global warming has changed the balance of summer and winter deaths in Australia. MethodsCounts of summer and winter cause‐specific deaths of subjects aged 55 and over for the years 1968–2018 were entered into a Poisson time‐series regression. Analysis was stratified by states and territories of Australia, by sex, age and cause of death (respiratory, cardiovascular, and renal diseases). The warmest and coldest subsets of seasons were compared. ResultsWarming over 51 years was associated with a long‐term increase in the ratio of summer to winter mortality from 0.73 in the summer of 1969 to 0.83 in the summer of 2018. The increase occurred faster in years that were warmer than average. ConclusionsMortality in the warmest and coldest times of the year is converging as annual average temperatures rise. Implications for public healthIf climate change continues, deaths in the hottest months will come to dominate the burden of mortality in Australia.

Seasonal variation of acute myocardial infarction deaths in Chile

Hospitalization and deaths due to cardiovascular diseases (CVD), have a peak in frequency during winter. To assess the existence of seasonal variation in deaths due to acute myocardial infarction (AMI) in Chile. Analysis of death report databases available at the website of the Chilean Ministry of Health. The seasonality of deaths due to AMI (codes ICD-10 I21, I22, I23) occuring in Chile between 2001-2016 were analyzed using a geometric model assuming a sinusoidal cyclic pattern. During the period 2001-2016, a total of 94,788 deaths due to AMI were registered, corresponding to 93,349 corrected deaths. Of the latter, 29.2% occurred in winter, 24.9% in spring, 24.0% in autumn and 21.8% in summer. The geometric model showed a marked sinusoidal pattern for the aggregated data. The peak-to-low ratio of deaths was 1.41 (95% CI 1.38-1.44). The peak of deaths occurred during July in 14 out of 16 years analyzed. In Chile, deaths due to AMI have a marked seasonal pattern, characterized by a higher number of deaths in winter and a lower number in summer.

Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway

BackgroundAlthough it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays.MethodsBaseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays.ResultsDuring 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year; being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant (P < 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed.ConclusionBeyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly; contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted.

Temperature and Solar Irradiance Effects on Pre-COVID Deaths in the Elderly

The tragedy of COVID in 2020 has highlighted ‘excess death rates’, but standard rates for different age groups must be understood before reliable excess rates can be calculated. This study analyses pre-COVID deaths in Ontario Canada and finds a clear association of death rate in elderly groups with weather as represented by downtown Toronto. Deaths in the younger groups are less dependent on weather.Colder temperatures coincide with higher deaths and the combination of cold temperatures plus low solar irradiance coincides with anomalously high winter deaths. Humidity and barometric pressure have minor associations.These relations provide a basic but useable means of forecasting elderly deaths throughout the year even with cause of death unknown. Deaths over a 2-week period can be predicted within reason based on the combination of diffuse irradiance of the past 4 weeks and temperature of the past 2 weeks. A standard weekly pre-COVID death rate can be determined with a correction made based on the weather of the immediate prior weeks.

Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England

ObjectiveExcess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter...

A Comparison of The Health Impacts of Individual Level and Area Based Welsh Government Fuel Poverty Schemes

IntroductionLiving in a cold and/or damp house is known to increase the risk of morbidity, mortality and excess winter deaths. To reduce fuel poverty in Wales, the Welsh Government developed schemes to provide energy efficiency improvements to those most likely affected by fuel poverty.&#x0D; We explored the relative impacts on health of an individual-level scheme, Warm Homes Nest, and an area-based scheme, Arbed.&#x0D; Objectives and ApproachOverall aim: to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty. Presented objective: to investigate the relative impact of the individual-level and area-based schemes on the health of recipients. A longitudinal dataset was created using the anonymised residence that received improvements linked to residents’ health measures using routine health records held in the SAIL Databank at Swansea University.&#x0D; We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention with any concurrent change in health in those yet to receive the intervention.&#x0D; ResultsAn analysis of the Warm Homes Nest Scheme, published in 2017 and presented at the IPDLN 2018 conference found a positive impact of the scheme on the health of recipients.&#x0D; This presentation will describe the further analysis comparing the area-based Arbed scheme with both the recipients of the individual-level Nest scheme and groups in comparable need that had not yet received the intervention. We will present results focussing on the relative impacts of the two schemes on respiratory health, infection prescribing and mental health.&#x0D; Conclusion / ImplicationsProviding home energy efficiency interventions has the potential to benefit population health, however there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively focussed home energy efficiency schemes and potentially thus improve the health and wellbeing of people living in Wales.

Excess winter mortality and stalling international improvements in life expectancy and mortality rates

In the UK, government austerity has been suggested as a major reason for the stalling of life expectancy improvements and age-standardised mortality rates. However, these trends have also been observed in many other countries. Influenza has been suggested as a potential confounding factor, as this condition contributes significantly to excess winter mortality (EWM) rates each year. This study uses calculated EWM rates in 64 countries with more than 12 000 deaths per annum to show that the decade before the financial crash was characterised by lower than average rates of EWM. The observed international stalling in life expectancy may therefore have been happening as early as the year 2000 but may have been partly masked by a decade of lower than usual winter deaths. From a health service perspective, EWM is also a source of winter bed pressures because of the associated medical admissions. The coincidental decade of low EWM rates may have also created a false picture of low winter demand, to which managers will have responded by trimming resources. This will, in part, have contributed to current winter pressures as EWM rates have returned to more ‘normal’ levels.

The associations between thermal variety and health: Implications for space heating energy use.

Fossil fuels dominate domestic heating in temperate climates. In the EU, domestic space heating accounts for around 20% of final energy demand. Reducing domestic demand temperatures would reduce energy demand. However, cold exposure has been shown to be associated with adverse health conditions. Using an observational dataset of 77,762 UK Biobank participants, we examine the standard deviation of experienced temperature (named here thermal variety) measured by a wrist worn activity and temperature monitor. After controlling for covariates such as age, activity level and obesity, we show that thermal variety is 0.15°C 95% CI [0.07-0.23] higher for participants whose health satisfaction was 'extremely happy' compared to 'extremely unhappy'. Higher thermal variety is also associated with a lower risk of having morbidities related to excess winter deaths. We argue that significant CO2 savings would be made by increasing thermal variety and reducing domestic demand temperatures in the healthiest homes. However, great care is needed to avoid secondary health impacts due to mould and damp. Vulnerable households should receive increased attention.

Draft Genome Sequence Resource for Blumeriella jaapii, the Cherry Leaf Spot Pathogen.

Blumeriella jaapii is the causal agent of cherry leaf spot (CLS), the most important disease of tart cherry in the Midwestern United States. Infection of leaves by B. jaapii leads to premature defoliation, which places trees at heightened risk of winter injury and death. Current management of CLS relies primarily on the application of three important fungicide classes, quinone outside inhibitors, sterol demethylation inhibitors, and succinate dehydrogenase inhibitors. Here, we present the first high-quality genome of B. jaapii through a hybrid assembly of PacBio long reads and Illumina short reads. The assembled draft genome of B. jaapii is 47.4 Mb and consists of 95 contigs with a N50 value of 1.5 Mb. The genomic information of B. jaapii, representing the most complete sequenced genome of the family Dermateaceae (Ascomycota) to date, provides a valuable resource for identifying fungicide resistance mechanisms of this pathogen and expands our knowledge of the phytopathogenic fungi in this family.

Energy poverty analyzed considering the adaptive comfort of people living in social housing in the central-south of Chile

Energy poverty (EP) occurs when there are no energy services available or not at an affordable price, or when homes are not capable of maintaining minimum thermal comfort conditions. It is associated with a series of adverse consequences for the people's health and with a higher number of deaths in winter in most European countries. The objective of this research was to study whether the thermal comfort levels, the state of the dwellings, the heating systems, the energy expenses, the respiratory illnesses and the medical expenses reported by social housing inhabitants in central-south Chile, were correlated, to determine which variables or combination of variables are more related with EP situations. To define the thermal comfort limits, a recently published adaptive thermal comfort model for low income housing in Chile was used. The results show that a third of those surveyed were not capable of keeping their home comfortable for at least 80% of the time and more than a fifth were incapable of doing so 65% of the time. Only 10% of those who were capable of keeping comfort levels more than 90% of the time, spend less than US$ 40 a month, which represents 10% of the minimum Chilean wage. Reducing the time that temperatures are below the lower comfort limit to 10% can mean a reduction in the number of respiratory illnesses and medical expenses.