title: Increase in mortality due to myocardial infarction in the Brazilian city of São Paulo during winter.
abstract: OBJECTIVE
  To study the seasonal variation in mortality due to myocardial infarction in the city of São Paulo.
  
  
  METHODS
  We analyzed the database of PROAIM (Programa de Aprimoramento de Informações de Mortalidade) containing the registrations of the certificates of deaths due to myocardial infarction (International Classification of Diseases, 10th edition, classification I21) of the residents of the municipality of São Paulo during 12 months (from December 1996 to November 1997). The number of deaths was corrected for a standard period of 90 days and then it was divided by the corresponding population to obtain the event rate per 10 thousand inhabitants. The magnitude of the seasonal variation, which was defined by the difference of the relative risks between the seasons with higher and lower mortality, was estimated.
  
  
  RESULTS
  A total of 5,615 deaths due to myocardial infarction were included in the study. Sixty-one per cent occurred in the male sex, and the mean age was 68 years. The mortality rate during winter was always higher and that during summer was lower than that during the other seasons (P<0.01), independent from age and sex. Seasonal variations in deaths due to myocardial infarction was 30% in the general group, being 23% in individuals who died younger than 75 years, and 44% in the older ones.
  
  
  CONCLUSIONS
  A marked seasonal variation in mortality due to myocardial infarction was observed in the city of São Paulo, with a significant increase in its magnitude and age distribution during the winter, similar to those reported in regions of North America and Europe with temperate climates.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Univerisdade de São Paulo, São Paulo, SP, 04605-004, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sharovsky
authors.forename: Luiz Antônio Machado
authors.initials: LA
authors.lastname: Cé sar
mesh_terms: D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003080:Cold Temperature; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D012621:Seasons; D017678:Sex Distribution