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Original Article |
1 London School of Hygiene & Tropical Medicine
2 London School of Hygiene and Tropical Medicine
* To whom correspondence should be addressed. E-mail: shakoor.hajat{at}lshtm.ac.uk.
Accepted 3 September 2006
 | Abstract |
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Objectives: Despite the high burden from exposure to both hot and cold weather each year in England and Wales, there has been relatively little investigation into who is most at risk, resulting in uncertainties in informing Government interventions. We determine here the subgroups of the population who are most vulnerable to heat- and cold-related mortality. Methods: Ecological time-series study of daily mortality in all regions of England and Wales between 1993-2003, with linkage of individual deaths to the CHIC database of care and nursing homes, and the 2001 UK census small area indicators. Results: A risk of mortality was observed for both heat and cold exposure in all regions, with strongest heat effects in London, and strongest cold effects in the Eastern region. For all regions, a combined RR of 1.03 (95% CI 1.02, 1.03) was estimated per degree increase above the heat threshold, and 1.06 (1.05, 1.06) per degree decrease below the cold threshold. Elderly people, particularly those in nursing and care homes were most vulnerable. The greatest risk of heat-mortality was observed for respiratory and external causes, and in women which remained after control for age. Vulnerability to either heat or cold was not modified by deprivation, except in rural populations where cold effects were slightly stronger in more deprived areas. Conclusions: Our results indicate that interventions to reduce vulnerability to both hot and cold weather should target all elderly people. Specific interventions should also be developed for people in nursing and care homes as heat illness is easily preventable. Deaths from external causes during hot weather in the 0-64 age-group represents substantial shortening of lives, and also should be considered in heat-warning systems.
Keywords: Climate change, Mortality, Temperature, Weather
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