title: Increased winter mortality from acute myocardial infarction and stroke: the effect of age.
abstract: OBJECTIVE
  We examined seasonal variations in mortality from acute myocardial infarction (AMI) and stroke by age using 300,000 deaths in the Canadian Mortality Database for the years 1980 to 1982 and 1990 to 1992.
  
  
  BACKGROUND
  The effect of age on environmental determinants of AMI and stroke is not well understood.
  
  
  METHODS
  Seasonal variations were analyzed by month and for the four seasons (winter beginning in December). A chi-square test was used to test for homogeneity at p < 0.01, and relative risk ratios (RRs) for high and low periods were determined in relation to the overall mean. For each of four age subgroups, the magnitude of the seasonal variation was reported as the difference in mortality between the highest and lowest frequency seasons.
  
  
  RESULTS
  By month, AMI deaths were highest in January (RR = 1.090) and lowest in September (RR = 0.904), a relative risk difference of 18.6%. The seasonal mortality variation in AMI deaths (winter vs. summer) increased with increasing age: 5.8% for <65, 8.3% for 65 to 74, 13.4% for 75 to 84 and 15.8% for >85 years (p < 0.005 for trend). Stroke mortality peaked in January (RR = 1.113) and had a trough in September (RR = 0.914), a relative risk difference of 19.9%. The seasonal variation in stroke mortality also increased with age. Seasonal variations were not seen in those aged <65 years, compared with 11.6% for 65 to 74, 15.2% for 75 to 84 and 19.3% for >85 years (p < 0.005 for trend).
  
  
  CONCLUSIONS
  The elderly demonstrate a greater winter increase in AMI and stroke mortality than younger individuals. An understanding of these seasonal patterns may provide novel avenues for research in cardiovascular disease prevention.
authors.affiliation: Preventive Cardiology and Therapeutics, Hamilton General Hospital and Division of Cardiology, McMaster University, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Sheth
authors.forename: C
authors.initials: C
authors.lastname: Nair
authors.forename: J
authors.initials: J
authors.lastname: Muller
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000401:mortality*; D019992:Databases as Topic / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality*; D012189:Retrospective Studies; D012621:Seasons; D015996:Survival Rate