Excess winter mortality in Europe: a cross country analysis identifying key risk factors

TLDR

Debate persists over why some European countries experience markedly higher winter mortality, with limited analysis of non‑cold factors and especially scarce research in southern Europe. The study aimed to identify key relationships between diverse risk factors and excess winter mortality across 14 EU countries using time‑series data. Researchers compiled longitudinal datasets on climate, macroeconomy, health care, lifestyle, socioeconomics, and housing, calculated seasonal mortality coefficients, and applied Poisson regression to detect seasonality associations. Poisson regression revealed that higher winter temperature and better housing thermal efficiency are associated with lower excess winter mortality, while higher income, health expenditure, and lower poverty, inequality, deprivation, and fuel poverty correlate with reduced mortality; Portugal, Spain, and Ireland had the highest excess winter mortality, suggesting that improving indoor thermal protection, health spending, and socioeconomic equity could lower seasonal deaths.

Abstract

Much debate remains regarding why certain countries experience dramatically higher winter mortality. Potential causative factors other than cold exposure have rarely been analysed. Comparatively less research exists on excess winter deaths in southern Europe. Multiple time series data on a variety of risk factors are analysed against seasonal-mortality patterns in 14 European countries to identify key relations Subjects and setting: Excess winter deaths (all causes), 1988-97, EU-14.Coefficients of seasonal variation in mortality are calculated for EU-14 using monthly mortality data. Comparable, longitudinal datasets on risk factors pertaining to climate, macroeconomy, health care, lifestyle, socioeconomics, and housing were also obtained. Poisson regression identifies seasonality relations over time.Portugal suffers from the highest rates of excess winter mortality (28%, CI=25% to 31%) followed jointly by Spain (21%, CI=19% to 23%), and Ireland (21%, CI=18% to 24%). Cross country variations in mean winter environmental temperature (regression coefficient (beta)=0.27), mean winter relative humidity (beta=0.54), parity adjusted per capita national income (beta=1.08), per capita health expenditure (beta=-1.19), rates of income poverty (beta=-0.47), inequality (beta=0.97), deprivation (beta=0.11), and fuel poverty (beta=0.44), and several indicators of residential thermal standards are found to be significantly related to variations in relative excess winter mortality at the 5% level. The strong, positive relation with environmental temperature and strong negative relation with thermal efficiency indicate that housing standards in southern and western Europe play strong parts in such seasonality.High seasonal mortality in southern and western Europe could be reduced through improved protection from the cold indoors, increased public spending on health care, and improved socioeconomic circumstances resulting in more equitable income distribution.