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Portugal and Spain most at risk from excess winter deaths in Europe

September 25, 2003

Portugal and Spain are the European countries most at risk from an excess of winter deaths, reveals research in the Journal of Epidemiology and Community Health. These countries are rarely thought to be at risk, because of their mild winter climates, say the authors, a notion that is “highly mistaken.”

The authors examined seasonal mortality trends in 14 European countries for the years 1988 to 1997. And they looked at long term data collected on climate, the economy, health care, lifestyle, socioeconomic factors and housing.

Portugal came top of the European league, with an excess of almost 9000 deaths during the winter for each of the years studied. This amounts to an excess seasonal mortality of 28%. Spain and Ireland were in joint second place with an excess winter mortality of 21%. The UK and Greece came joint third with an excess of 18%, although when assessed separately, England had the highest excess rate of all the UK countries at 19%.

At the bottom of the league were Finland, Germany, and the Netherlands.

While different factors exerted different levels of influence in each of the countries studied, certain common risks emerged. These included low temperature, humidity, health expenditure per head of the population, inequality, deprivation and inability to pay for fuel. Several markers of inadequate indoor warmth at home were also significantly associated with excess winter deaths.

The strong effects of environmental temperature and heating efficiency indicate that poor housing standards in parts of southern and western Europe have a strong impact on seasonal mortality, say the authors.

The authors declare their results to be “startling,” adding that it is something of a paradox that countries with the mildest climates, where average temperatures remain above 5 degrees Centigrade during the winter, have the most striking variations in seasonal mortality.

They suggest that these excess deaths could be reduced by better housing standards and increased public spending on healthcare.

British Medical Journal (BMJ)