Temperature, housing, deprivation and their relationship to excess winter mortality in Great Britain, 1986-1996

Objectives To examine the associations between temperature, housing, depriv ation and excess winter mortality using census variables as proxies for hou sing conditions. Design Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996. Participants Men and women aged 65 and over. Main outcome measures Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (I CD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-5 19). Odds of death occurring in winter period of the four months December t o March compared to the rest of the year. Results During the study period (excluding the influenza epidemic year of 1 989/90), a total of 1 682 687 deaths occurred in winter and 2 825 223 death s occurred during the rest of the year among people aged greater than or eq ual to 165 (around 30 000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categorie s (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 I IC reduction in 24-h mean winter temperature. The amount of rain, wind and hou rs of sunshine were inversely associated with excess winter mortality. Sele cted housing variables derived from the English House Condition Survey show ed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation an d 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). Conclusions Excess winter mortality continues to be an important public hea lth problem in Great Britain. There was a strong inverse association with t emperature. Lack of central heating was associated with higher excess winte r mortality. Further work is needed to disentangle the complex relationship s between different indicators of housing quality and other measures of soc ioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.