Excess winter mortality: influenza or cold stress? Observational study

BMJ 2002; 324 doi: 10.1136/bmj.324.7329.89 (Published 12 January 2002)
Cite this as: BMJ 2002;324:89.1
  1. G C Donaldson, senior research associate,
  2. W R Keatinge, emeritus professor (w.r.keatinge@qmw.ac.uk)
  1. Medical Sciences, Division of Biomedical Sciences, Queen Mary and Westfield College, London E1 4NS
  1. Correspondence to: W R Keatinge
  • Accepted 10 July 2001

Epidemics of influenza are associated with increases in mortality and morbidity.1 Health professionals and the media, therefore, have often focused their attention on influenza as a cause of increased mortality and demands on health services in winter. Cold weather alone causes striking short term increases in mortality, mainly from thrombotic and respiratory disease.2 Non-thermal seasonal factors such as diet may also affect mortality.3 The increases in mortality are greater in London than in regions surveyed in continental Europe.4 We used multiple regression to assess the proportion of excess winter mortality that was attributable to influenza in south east England.

Methods and results

A daily record was kept of deaths that occurred in south east England from 1970 to 1999 for all causes and for influenza. We obtained daily estimates of population by linear regression from mid-year values (17.2×106 in 1971 and 18.4×10 …

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