title: Public health vulnerability to wintertime weather: time-series regression and episode analyses of national mortality and morbidity databases to inform the Cold Weather Plan for England.
abstract: OBJECTIVE
  To inform development of Public Health England's Cold Weather Plan (CWP) by characterizing pre-existing relationships between wintertime weather and mortality and morbidity outcomes, and identification of groups most at risk.
  
  
  METHODS
  Time-series regression analysis and episode analysis of daily mortality, emergency hospital admissions, and accident and emergency visits for each region of England.
  
  
  METHODS
  Seasonally-adjusted Poisson regression models estimating the percent change in daily health events per 1 °C fall in temperature or during individual episodes of extreme weather.
  
  
  RESULTS
  Adverse cold effects were observed in all regions, with the North East, North West and London having the greatest risk of cold-related mortality. Nationally, there was a 3.44% (95% CI: 3.01, 3.87) increase in all-cause deaths and 0.78% (95% CI: 0.53, 1.04) increase in all-cause emergency admissions for every 1 °C drop in temperature below identified thresholds. The very elderly and people with COPD were most at risk from low temperatures. A&E visits for fractures were elevated during heavy snowfall periods, with adults (16-64 years) being the most sensitive age-group. Since even moderately cold days are associated with adverse health effects, by far the greatest health burdens of cold weather fell outside of the alert periods currently used in the CWP.
  
  
  CONCLUSIONS
  Our findings indicate that levels 0 ('year round planning') and 1 ('winter preparedness and action') are crucial components of the CWP in comparison to the alerts. Those most vulnerable during winter may vary depending on the type of weather conditions being experienced. Recommendations are made for the CWP.
authors: London School of Hygiene & Tropical Medicine, UK. Electronic address: shakoor.hajat@lshtm.ac.uk.
authors: S
authors: S
authors: Hajat
authors: London School of Hygiene & Tropical Medicine, UK.
authors: Z
authors: Z
authors: Chalabi
authors: London School of Hygiene & Tropical Medicine, UK.
authors: P
authors: P
authors: Wilkinson
authors: London School of Hygiene & Tropical Medicine, UK.
authors: B
authors: B
authors: Erens
authors: London School of Hygiene & Tropical Medicine, UK.
authors: L
authors: L
authors: Jones
authors: London School of Hygiene & Tropical Medicine, UK.
authors: N
authors: N
authors: Mays
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature / Q000009:adverse effects*; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D006285:Health Planning; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D065186:Interrupted Time Series Analysis; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D012044:Regression Analysis; D012307:Risk Factors; D012621:Seasons; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cold weather; Morbidity; Mortality; Temperature; Time-series; Winter