title: Association of seasonal climate variability and age-specific mortality in northern Sweden before the onset of industrialization.
abstract: OBJECTIVE
  Little is known about health impacts of climate in pre-industrial societies. We used historical data to investigate the association of temperature and precipitation with total and age-specific mortality in Skellefteå, northern Sweden, between 1749 and 1859.
  
  
  METHODS
  We retrieved digitized aggregated population data of the Skellefteå parish, and monthly temperature and precipitation measures. A generalized linear model was established for year to year variability in deaths by annual and seasonal average temperature and cumulative precipitation using a negative binomial function, accounting for long-term trends in population size. The final full model included temperature and precipitation of all four seasons simultaneously. Relative risks (RR) with 95% confidence intervals (CI) were calculated for total, sex- and age-specific mortality.
  
  
  RESULTS
  In the full model, only autumn precipitation proved statistically significant (RR 1.02; CI 1.00-1.03, per 1cm increase of autumn precipitation), while winter temperature (RR 0.98; CI 0.95-1.00, per 1 °C increase in temperature) and spring precipitation (RR 0.98; CI 0.97-1.00 per 1 cm increase in precipitation) approached significance. Similar effects were observed for men and women. The impact of climate variability on mortality was strongest in children aged 3-9, and partly also in older children. Infants, on the other hand, appeared to be less affected by unfavourable climate conditions.
  
  
  CONCLUSIONS
  In this pre-industrial rural region in northern Sweden, higher levels of rain during the autumn increased the annual number of deaths. Harvest quality might be one critical factor in the causal pathway, affecting nutritional status and susceptibility to infectious diseases. Autumn rain probably also contributed to the spread of air-borne diseases in crowded living conditions. Children beyond infancy appeared most vulnerable to climate impacts.
authors.affiliation: Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden. joacim.rocklov@umu.se.
authors.forename: Joacim
authors.initials: J
authors.lastname: Rocklöv
authors.affiliation: Demographic Database, Umeå University, Umeå 90187, Sweden. soren.edvinsson@ddb.umu.se.
authors.forename: Sören
authors.initials: S
authors.lastname: Edvinsson
authors.affiliation: Department of Mathematics and Mathematical Statistics, Umeå University, Umeå 90187, Sweden. per.arnqvist@math.umu.se.
authors.forename: Per
authors.initials: P
authors.lastname: Arnqvist
authors.affiliation: Department of Mathematics and Mathematical Statistics, Umeå University, Umeå 90187, Sweden. sara.de.luna@math.umu.se.
authors.forename: Sara Sjöstedt
authors.initials: SS
authors.lastname: de Luna
authors.affiliation: Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden. barbara.schumann@umu.se.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schumann
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002980:Climate; D006801:Humans; D007221:Industry; D007223:Infant; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012621:Seasons; D013548:Sweden / Q000453:epidemiology; D014887:Weather; D055815:Young Adult