title: Influence of climate variability on acute myocardial infarction mortality in Havana, 2001-2012.
abstract: Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality.
  
  
  
  Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001-2012 in Havana.
  
  
  
  An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21-I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%.
  
  
  
  The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November-April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May-October). A downward trend in total number of deaths can be seen starting with the change point in April 2009.
  
  
  
  Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality's seasonal pattern.
authors.affiliation: Climate Center, Meteorology Institute (CLIM), Havana, Cuba. riverovalencia19@gmail.com.
authors.forename: Alina
authors.initials: A
authors.lastname: Rivero
authors.forename: Javier
authors.initials: J
authors.lastname: Bolufé
authors.forename: Paulo L
authors.initials: PL
authors.lastname: Ortiz
authors.forename: Yunisleydi
authors.initials: Y
authors.lastname: Rodríguez
authors.forename: María C
authors.initials: MC
authors.lastname: Reyes
mesh_terms: D002423:Cause of Death; D002980:Climate; D003462:Cuba / Q000453:epidemiology; D003644:Death Certificates; D064308:Ecological Parameter Monitoring / Q000706:statistics & numerical data; D059000:El Nino-Southern Oscillation / Q000009:adverse effects; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D012621:Seasons; D017678:Sex Distribution; D014887:Weather