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Winter mortality and cold stress in Yekaterinburg, Russia: interview survey

^a Department of Physiology, Basic Medical Sciences, Queen Mary and Westfield College, University of London, London E1 4NS, ^b Russian Ministry of Health, 11 Dobrolubova Street, Moscow 127254, Russia, ^c Dezemat Biosynoptik der Zentralen Medizin-Meteorologischen Forschungsstelle des Deutschen Wetterdienstes, Stefan Maier Strasse 4, 7800 Freiburg 1, Germany

Correspondence to: Professor Keatinge w.r.keatinge@qmw.ac.uk

Objectives: To evaluate how mortality and protective measures against exposure to cold change as temperatures fall between October and March in a region of Russia with a mean winter temperature below -6 °C.
Design: Interview to assess factors associated with cold stress both indoors and outdoors, to measure temperatures in living room, and to survey unheated rooms.
Setting: Sverdlovsk Oblast (district), Yekaterinburg, Russia.
Subjects: Residents aged 50-59 and 65-74 living within approximately 140 km of Yekaterinburg in Sverdlovsk Oblast. Survey of sample of 1000 residents equally distributed by sex and age groups.
Main outcome measures: Regression analysis was used to relate data on indoor heating and temperatures, the amount of clothing worn, the amount of physical activity, and shivering while outside, to outdoor temperature; results were compared with mortality patterns for ischaemic heart disease, cerebrovascular disease, respiratory disease, and mortality from all causes.
Results: As mean daily temperatures fell to 0°C the amount of clothing worn outdoors increased, physical activity while outdoors became more continuous, and only 11 (6.6%) of the 167 people surveyed who went outdoors at temperatures above 0°C reported shivering. The mean temperature in living rooms in the evening remained above 21.9°C. Mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes did not change. As the temperature fell below 0°C the number of items of clothing worn plateaued at 16.0 and the number of layers at 3.7. With regression analysis, shivering outdoors was found to increase progressively to 34.6% (P<0.001) of excursions at -25°C, and mortality (after declining slightly) rose progressively (all cause mortality rose by 1.15% for each 1°C drop in temperature from 0°C to -29.6°C, 95% confidence interval 0.97% to 1.32%). 94.2% of bedrooms were directly heated, and evening temperatures in the living room averaged 19.8°C even when outside temperatures reached -25°C.
Conclusions: Outdoor cold stress and mortality in Yekaterinburg increased only when the mean daily temperature dropped below 0°C. At temperatures down to 0°C cold stress and excess mortality were prevented by increasing the number of items of clothing worn and the amount of physical activity outdoors in combination with maintaining warmth in houses.

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