title: The association of cold weather and all-cause and cause-specific mortality in the island of Ireland between 1984 and 2007.
abstract: BACKGROUND
  This study aimed to assess the relationship between cold temperature and daily mortality in the Republic of Ireland (ROI) and Northern Ireland (NI), and to explore any differences in the population responses between the two jurisdictions.
  
  
  METHODS
  A time-stratified case-crossover approach was used to examine this relationship in two adult national populations, between 1984 and 2007. Daily mortality risk was examined in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter (December-February) and an extended cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship.
  
  
  RESULTS
  In the ROI, the impact of cold weather in winter persisted up to 35 days, with a cumulative mortality increase for all-causes of 6.4% (95% CI = 4.8%-7.9%) in relation to every 1°C drop in daily maximum temperature, similar increases for cardiovascular disease (CVD) and stroke, and twice as much for respiratory causes. In NI, these associations were less pronounced for CVD causes, and overall extended up to 28 days. Effects of cold weather on mortality increased with age in both jurisdictions, and some suggestive gender differences were observed.
  
  
  CONCLUSIONS
  The study findings indicated strong cold weather-mortality associations in the island of Ireland; these effects were less persistent, and for CVD mortality, smaller in NI than in the ROI. Together with suggestive differences in associations by age and gender between the two Irish jurisdictions, the findings suggest potential contribution of underlying societal differences, and require further exploration. The evidence provided here will hope to contribute to the current efforts to modify fuel policy and reduce winter mortality in Ireland.
authors.affiliation: Institute for the Environment, Brunel University London, London, UK. Ariana.Zeka@brunel.ac.uk.
authors.forename: Ariana
authors.initials: A
authors.lastname: Zeka
authors.affiliation: Institute for the Environment, Brunel University London, London, UK. Stephen.Browne@brunel.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Browne
authors.affiliation: Institute of Public Health Ireland, Dublin, Ireland. Helen.McAvoy@publichealth.ie.
authors.forename: Helen
authors.initials: H
authors.lastname: McAvoy
authors.affiliation: Environmental Health Sciences Institute, Dublin Institute of Technology, Dublin, Ireland. patrick.goodman@dit.ie.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003080:Cold Temperature / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009660:Northern Ireland / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012621:Seasons; D055815:Young Adult