Name: Louise M Tanner Organisation: Newcastle University Research funder:
ESRC (North-East Doctoral Training Centre)
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Outline
Background
2. Methods
3. Results
4. Discussion
1.
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Background (i): Excess Winter Mortality
 Mortality rates in many countries are higher during the
winter period (December to March / June to September)
than at other times of the year.
 Deaths mainly attributable to cardiovascular and
respiratory illnesses.
 Spatial and temporal variations in excess winter mortalities
‘Paradox of EWM’. 1 Causes not fully understood.
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Research context (ii): wider health and social impacts
 Indirect health effects include: Impaired nutrition and lifestyle choices
(‘heat or eat’; social exclusion); Immune suppression; Exacerbation of existing
illnesses; Impact on emotional health and wellbeing; Effects felt across the
lifespan.
 Wider socio-economic costs:
 Cold housing associated with educational under-attainment, fuelling a cycle of
poverty in poorer communities. 2-3
 Costs to the NHS in treating people suffering from a wide range of illnesses
linked directly to living in cold, damp and often dangerous homes: > £2bn a
year. 2-3
 Cost of police responses to crimes associated with substandard housing:
~£1.8bn a year. 2-3
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Background (iii): Socio-economic and behavioural risk
factors.
 Complex interplay of risk factors, some of which are modifiable
 Socio-economic and housing factors:
Measures of socio-economic status and deprivation
Housing: condition, thermal efficiency, location, occupancy and tenure
Fuel poverty
 Behavioural factors:
Physical activity levels
Smoking
Clothing
Diet
Excursion patterns
Vaccination status
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Research aims / plan
1. A systematic review to identifying key socio-economic and behavioural
risk factors for adverse winter health and social outcomes
2. Development of a theoretical model of causal pathways
3. Test and refine the model using existing datasets.
4. Model the impact of interventions.
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Methods (i)
Searches
 Systematic methods used to identify, synthesise and
evaluate quantitative, observational research
 Medical, social science and grey literature sources;
expert contacts.
 Key words relating to climatic and mediators.
Outcomes not specified.
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Methods (ii)
Inclusion criteria:
 Primary observational studies and systematic reviews
 Quantify associations between cold exposure,
SE/Housing/behavioural factors and health or social
outcomes.
 Published 2001-11 in English
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Results (i)
2745 unduplicated records identified; titles and abstracts
screened for relevance
365 full texts screened against inclusion criteria
33 records included in review
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Results (ii)
 Low income, Fuel Poverty; low indoor temperature
and poor thermal efficiency were most consistently
associated with adverse health outcomes.
 Most studies conducted in the UK, Northern Europe or
New Zealand.
 Socio-demographic effect modifiers identified: age,
(female) sex, health status, smoking status,
psychological variables.
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Discussion
 Review identified socio-economic, housing and
behavioural factors associated with adverse winter
health outcomes.
 Limitations: heterogeneous studies – hard to
generalize results; exclusion of qualitative and
intervention studies; study limitations, see below
 Further research: individual level studies, larger
samples, longer duration, more control for
confounders, wider socio-economic impacts.
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 Populated model…
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Questions or Comments?
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References
1.
2.
3.
Healy, JD. Excess winter mortality in Europe: a cross country analysis
identifying key risk factors. J Epidemiol Community Health. 2003;57:784-9.
Friedman D. Social impact of poor housing. Friedman, Ecotec March 2010
Available from:
http://www.settledhousing.co.uk/Portals/0/Socialmpactpoorhousing%5B1%
5D.pdf (Accessed 19 11 2012)
Mawle A. Healthy Housing, Healthy People? Presented at the Keeping Warm
in Later Life conference, Rotherham. 2011. Available from:
http://www.kwillt.org/index.php/consultation-event (accessed 20 October
2011).
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Additional references (i)
 Telfar-Barnard LF, Baker MG, Hales S, Howden-Chapman PL. Excess Winter
Morbidity and Mortality: Do Housing and Socio-Economic Status Have an
Effect? Reviews on Environmental Health 2008;23:203-
 Thomson H, Thomas S, Sellstrom E, et al. The Health Impacts of Housing
Improvement: A Systematic Review of Intervention Studies From 1887 to 2007.
Am J Public Health 2009;99:S681-92.
 Lawlor D A, Maxwell R, Wheeler B W. Rurality, deprivation, and excess winter
mortality: an ecological study J Epidemiol Community Health 2002;56:373-374
 Goodwin J, Taylor RS and Pearce VR. Seasonal cold, excursional behaviour,
clothing protection and physical activity in young and old adults. Int J Health
2000; 59: 195-203.
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Additional references (ii)
 Wilkinson P, Pattenden S, Armstrong B, Fletcher, A, Kovats RS, Mangtani P
and McMichael AJ. Vulnerability to winter mortality in elderly people in
Britain: population based study. BMJ 2004; 329: 647.
 Donaldson GC, Rintamaki H and Nayha S Outdoor clothing: its relationship to
geography, climate, behaviour and cold-related mortality in Europe.
International Journal of Biometeorology 2001; 45: 45-51.
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