title: Geographical variation in relative risks associated with cold waves in Spain: The need for a cold wave prevention plan.
abstract: In general, there are few studies that analyse the impact of low temperatures on mortality and fewer still that use cold-wave-definition thresholds based on epidemiological and non-climatological criteria. Such a threshold definition, which took into account population features such as socio-economic and demographic characteristics, made it possible for a specific threshold temperature to be obtained for each of Spain's 52 provincial capitals in this study. Using generalised linear models with the Poisson regression link, and controlling for trend, autocorrelations and seasonalities of the series, and influenza epidemics, we obtained the impact of low temperatures on mortality in each provincial capital by calculating the relative risks (RRs) and attributable risks (ARs) for natural as well as circulatory and respiratory causes. The study showed higher minimum temperature thresholds in coastal areas, and an overall impact of cold on mortality in Spain due to natural causes RR=1.13 (95% CI: 1.11-1.16), circulatory causes RR=1.18 (95% CI: 1.15-1.22) and respiratory causes RR=1.24 (95% CI: 1.20-1.29) slightly greater than that obtained to date for heat. From a public health standpoint, there is a need for specific cold wave prevention plans at a regional level which would enable mortality attributable to low temperatures to be reduced. These plans have shown themselves to be effective in decreasing heat-related mortality, and we feel that they are essential for reducing cold-related effects on morbidity and mortality.
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain. Electronic address: rocio.carmona@isciii.es.
authors.forename: R
authors.initials: R
authors.lastname: Carmona
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Díaz
authors.affiliation: Torrijos Public Health District, Castile-La Mancha Regional Health & Social Affairs Authority (Consejería de Sanidad y Asuntos Sociales de Castilla-La Mancha), Torrijos, Toledo, Spain.
authors.forename: I J
authors.initials: IJ
authors.lastname: Mirón
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ortíz
authors.affiliation: National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: León
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Linares
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D055873:Extreme Cold / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011314:Preventive Health Services / Q000379:methods; D011634:Public Health; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Cold waves; Geographical variation; Mortality; Prevention plans; Relative risks