Aylin P, Morris S, Wakefield J, Grossinho A, Jarup L, Elliott P
Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Imperial College School of Medicine, London W2 1PG, UK.
Int J Epidemiol. 2001 Oct;30(5):1100-8. doi: 10.1093/ije/30.5.1100.
To examine the associations between temperature, housing, deprivation and excess winter mortality using census variables as proxies for housing conditions.
Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996.
Men and women aged 65 and over.
Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (ICD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-519). Odds of death occurring in winter period of the four months December to March compared to the rest of the year.
During the study period (excluding the influenza epidemic year of 1989/90), a total of 1,682,687 deaths occurred in winter and 2,825,223 deaths occurred during the rest of the year among people aged > or =65 (around 30,000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categories (P < 0.01). There was a significant association between winter mortality and temperature with a 1.5% higher odds of dying in winter for every 1 degrees C reduction in 24-h mean winter temperature. The amount of rain, wind and hours of sunshine were inversely associated with excess winter mortality. Selected housing variables derived from the English House Condition Survey showed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation and excess winter mortality, although lack of central heating was associated with a higher risk of dying in winter (odds ratio [OR] = 1.016, 95% CI : 1.009-1.022).
Excess winter mortality continues to be an important public health problem in Great Britain. There was a strong inverse association with temperature. Lack of central heating was associated with higher excess winter mortality. Further work is needed to disentangle the complex relationships between different indicators of housing quality and other measures of socioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.
使用人口普查变量作为住房条件的替代指标，研究温度、住房、贫困与冬季超额死亡率之间的关联。
选区层面的小区域生态研究。研究范围为1986年至1996年的英国。
65岁及以上的男性和女性。
各种原因导致的死亡（国际疾病分类第九版[ICD-9]编码0 - 999）、冠心病（ICD-9 410 - 414）、中风（ICD-9 430 - 438）和呼吸系统疾病（ICD-9 460 - 519）。与一年中其他时间相比，12月至次年3月这四个月冬季期间死亡的几率。
在研究期间（不包括1989/90年流感流行年份），65岁及以上人群中冬季共发生1,682,687例死亡，其余时间发生2,825,223例死亡（每年约有30,000例冬季超额死亡）。在所有疾病类别中，冬季超额死亡率随年龄增长呈明显上升趋势（P < 0.01）。冬季死亡率与温度之间存在显著关联，冬季24小时平均温度每降低1摄氏度，冬季死亡几率就会高出1.5%。降雨量、风速和日照时长与冬季超额死亡率呈负相关。从英国住房状况调查得出的选定住房变量与选区层面的人口普查衍生变量几乎没有一致性。对于全因死亡率，贫困与冬季超额死亡率之间几乎没有关联，尽管缺乏中央供暖与冬季死亡风险较高相关（比值比[OR] = 1.016，95%置信区间：1.009 - 1.022）。
冬季超额死亡率在英国仍然是一个重要的公共卫生问题。与温度呈强烈负相关。缺乏中央供暖与较高的冬季超额死亡率相关。需要进一步开展工作，以理清住房质量的不同指标与社会经济剥夺的其他衡量标准之间的复杂关系，以及它们与英国大量冬季超额死亡之间的关系。
