title: Evidence of social deprivation on the spatial patterns of excess winter mortality.
abstract: OBJECTIVE
  The aims of this study are to identify the patterns of excess winter mortality (due to diseases of the circulatory system) and to analyse the association between the excess winter deaths (EWD) and socio-economic deprivation in Portugal.
  
  
  METHODS
  The number of EWD in 2002-2011 was estimated by comparing the number of deaths in winter months with the average number in non-winter months. The EWD ratio of each municipality was calculated by following the indirect standardization method and then compared with two deprivation indexes (socio-material and housing deprivation index) through ecological regression models.
  
  
  RESULTS
  This study found that: (1) the EWD ratio showed considerable asymmetry in its geography; (2) there are significant positive associations between the EWD ratio and both deprivation indexes; and (3) at the higher level of deprivation, housing conditions have a stronger association with EWD than socio-material conditions.
  
  
  CONCLUSIONS
  The significant association between two deprivation dimensions (socio-material and housing deprivation) and EWDs suggests that EWD geographical pattern is influenced by deprivation.
authors.affiliation: Centre of Studies on Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal. ricardoalmendra85@gmail.com.|Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal. ricardoalmendra85@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Almendra
authors.affiliation: Centre of Studies on Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal.|Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Santana
authors.affiliation: GITUR, Instituto Politécnico de Leiria, Leiria, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Vasconcelos
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D054624:Health Status Disparities; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D009026:Mortality / Q000639:trends; D011174:Portugal / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data*; D012621:Seasons; D062206:Spatial Analysis
keywords: Environmental vulnerability; Excess winter deaths; Socio-economic deprivation