Multiple Deprivation and Excess Winter Deaths in Scotland

By Howieson, Stirling G.; Hogan, M. | The Journal of the Royal Society for the Promotion of Health, January 2005 | Go to article overview

Multiple Deprivation and Excess Winter Deaths in Scotland


Howieson, Stirling G., Hogan, M., The Journal of the Royal Society for the Promotion of Health


Key words

Energy efficiency; excess winter deaths; fuel poverty; multiple deprivation

Abstract

The recent publication of the Scottish Index of Multiple Deprivation (SIMD) has allowed some tentative statistical correlations to be undertaken to assess the impact poverty may have on mortality and morbidity. During the period 1989 to 2001, Scotland registered around 51,600 excess winter deaths (EWDs). An EWD is taken as the additional deaths during December to March than occurred in the preceding and subsequent four-month periods. Almost all of these EWDs were in the population aged over 65. This represents 50 more deaths per day in January than in July. The SIMD measured five criteria by region: income; employment; health and disability; education, skills and training; and geographical access to services. Glasgow was the most deprived region with an SIMD score of 46.88 and East Dunbartonshire, the least deprived region, with a score of 9.07. For the over 65s, the chance of becoming an EWD in Glasgow is one in 36, rising to one in 68 for North Ayrshire. The SIMD is positively correlated with EWD by region (0.35 at the 5% confidence level).

This correlation appears to go against the influence of climatic variations, house type, energy efficiency and access to the gas network which favours urban areas. Although some of the additional winter deaths have been ascribed to outdoor cold exposure - exacerbated by inappropriate clothing or culturally determined behaviour - the majority of EWDs are premature and essentially preventable if the elderly can be kept warm in their homes during the winter months.

INTRODUCTION

In 1991 Boardman1 demonstrated that the UK has 30,000 to 60,000 more deaths between December and March than in the preceding and succeeding four-month periods. Although there is some evidence demonstrating a reducing trend in excess winter deaths (EWDs) in London and Scotland2,3 - possibly due to increased levels of energy efficiency - the UK has much higher winter death rates than other countries with similar or more severe climates, implying that it is not outdoor exposure to cold that is the key determinant. Northern Finland - where winter temperatures regularly drop to minus 20°C - has a significantly lower rate of EWDs than London;4 however, Finnish dwellings have historically had much higher levels of insulation and whole house central heating is commonplace. In the UK, 90% of the EWDs are in the elderly population and are registered under three generic disease headings: ischaemic heart, cerebro-vascular and respiratory.5 An EWD is taken as the additional deaths during December to March than occurred in the preceding and subsequent four-month periods.

COLD DAMP HOUSING AND POOR HEALTH

Although some of the additional winter deaths have been ascribed by the Eurowinter Group4 as being due to external exposure - exacerbated by inappropriate clothing or culturally-determined behaviour - there remains an acceptance that the majority of these deaths are essentially preventable if the elderly can be kept warm in their homes during the winter months.

The biological mechanisms resulting from a lowering in core body temperatures are well known.6 The body's defence against cold is to shut down blood vessels in the skin to reduce heat loss from the core. This displaces around a litre of blood and overloads the central organs. In order to reduce this excess, salt and water are excreted. This in turn requires more salt and water to leave the bloodstream through the walls of the blood capillaries. This adjusts the blood volume to the reduced capacity of the circulatory system, but leaves the blood more concentrated. Some of the smaller molecules of the blood plasma - including the anti-thrombotic vitamin C - are able to redistribute through the capillary walls, but the red and white blood cells, platelets, fibrinogen and cholesterol are too large and remain in increased concentration in the blood plasma. …

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