title: Contribution of climate and air pollution to variation in coronary heart disease mortality rates in England.
abstract: There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999-2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment--temperature, hours of sunshine and air quality. Models were adjusted for deprivation, an index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p<0.05), suggesting that CHD mortality rates were higher in areas with lower average temperature and hours of sunshine. After adjustment for the unhealthy lifestyle of populations and deprivation, the climate variables explained at least 15% of large scale variation in CHD mortality rates. The results suggest that the climate has a small but significant independent association with CHD mortality rates in England.
authors.affiliation: British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, Headington, Oxford,United Kingdom. peter.scarborough@dph.ox.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Scarborough
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
authors.forename: Mike
authors.initials: M
authors.lastname: Rayner
authors.forename: Michael
authors.initials: M
authors.lastname: Goldacre
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002980:Climate; D003327:Coronary Disease / Q000139:chemically induced / Q000401:mortality*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005843:Geography; D006801:Humans; D008019:Life Style; D008297:Male; D055361:Multilevel Analysis; D012044:Regression Analysis; D012307:Risk Factors; D013472:Sunlight; D013696:Temperature