Elsevier

Public Health

Volume 141, December 2016, Pages 207-209
Public Health

Short Communication
An ecological study of excess winter mortality in England and deprivation

https://doi.org/10.1016/j.puhe.2016.09.023Get rights and content

Introduction

Excess winter mortality (EWM) is defined as the number of deaths occurring during winter months (December to March) compared to the average number of deaths across the rest of year.1 Over the last 10 years, EWM in England has accounted for, on average, 27,000 more deaths per year than would be expected.1

Whilst there is a relationship between EWM and fuel poverty, some previous studies have not established an association between EWM and deprivation.2, 3, 4 However, a systematic review investigating the association between socio-economic factors and EWM found that particular aspects of deprivation were more strongly associated with EWM than others, including income and housing conditions.5

It has been suggested that rural deprivation might be linked to higher levels of excess winter deaths. If this is the case, it would suggest that EWM is not only determined by temperature but also by modifiable factors and leads one to conclude that it is potentially preventable.6

One widely used measure of deprivation in England is the index of multiple deprivation (IMD) that uses seven domains of deprivation. Of previous research using the IMD, none have reviewed the association between EWM and deprivation by individual domains. Instead they have utilized the composite IMD, which includes the health domain. As a result, previous research may have underestimated the association between EWM and deprivation. Therefore, this research sought to investigate the association between EWM and deprivation according to particular domains of deprivation included within the IMD and by areas classified as urban and rural.

Section snippets

Study design

We conducted an ecological study using publicly available population-level data on deprivation and EWM across local authorities in England. For the purpose of the study, we defined EWM as the outcome with deprivation providing the exposure variable.

EWM data used for this study were published in November 2013 and used EWM figures for the winter of 2010/11.1 The year 2010/11 was chosen to align with the year of the exposure variable, the IMD 2010, which was published in March 2011. More recent

Results

Statistically significant positive weak associations were found between excess winter mortality and the index of multiple deprivation (r = 0.21, P < 0.001), income (r = 0.20, P < 0.001), employment (r = 0.23, P < 0.001), education (r = 0.29, P < 0.001), crime (r = 0.15, P = 0.01) and living environment (r = 0.14, P = 0.01). A significant negative very weak association was found with barriers to housing and services (r = –0.12, P = 0.03).

Correlation analysis for rural and urban areas resulted in a statistically significant

Strengths and limitations

The strengths of using an ecological study design were the use of a large routinely collected national data set for both EWM and IMD. However, as both exposure and outcome variables in this study are based on area-level data, there is the risk of ecological fallacy in that any results might be erroneously interpreted as applying to individuals living within these areas rather than to the areas themselves.8 A major limitation with this study design is that it is unable to determine causation.

Acknowledgements

The authors would like to thank Dr Andrea Venn for statistical advice and support for this work.

Ethical approval

None sought.

Funding

This work was undertaken as part of a Masters in Public Health dissertation. No additional funding was received for this work.

Competing interests

The authors have no competing financial interests.

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References (9)

  • ONS

    Excess winter mortality in England and Wales, 2012/13 (Provisional) and 2011/12 (Final)

    (2013)
  • S. Shah et al.

    Deprivation and excess winter mortality

    J Epidemiol Commun Health

    (1999)
  • D.A. Lawlor et al.

    Investigation of the association between excess winter mortality and socio-economic deprivation

    J Public Health Med

    (2000)
  • S. Hajat et al.

    Heat-related and cold-related deaths in England and Wales: who is at risk?

    Occup Environ Med

    (2007)
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