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Assessing Effect Modification of Excess Winter Death by Causes of Death and Individual Characteristics in Zhejiang Province, China: A Multi-Community Case-Only Analysis

1
School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 31004, China
3
Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
4
School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland 4059, Australia
*
Author to whom correspondence should be addressed.
These authors contributed to the work equally and should be regarded as co-first authors.
Int. J. Environ. Res. Public Health 2018, 15(8), 1663; https://doi.org/10.3390/ijerph15081663
Received: 2 July 2018 / Revised: 1 August 2018 / Accepted: 3 August 2018 / Published: 6 August 2018
(This article belongs to the Section Environmental Health)
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Abstract

Mortality in many parts of the world has a seasonal pattern, with a marked excess of deaths during winter. To date, however, there is very little published evidence on the nature of this wintertime excess in low- and middle-income countries. In this study, we aimed to quantify the extent of the death peak in winter and to assess effect modification on excess winter death (EWD) by individual characteristics and cause of deaths in China. We used a Cosinor model to examine seasonal patterns for specific causes of deaths and a case-only analysis of deaths in winter compared with other seasons to assess effect modification by individual characteristics. A total of 398,529 deaths were investigated between January 2010 and December 2013 in Zhejiang Province, China. Deaths peaked in winter, and overall mortality was around 30% higher in winter than in summer. Although diseases of the respiratory and circulatory systems were highly seasonal, surprisingly we observed that deaths from mental and behavioral disorders exhibited greater fluctuation. Males, the elderly and illiterate individuals suffered high EWD. EWDs were also particularly common in emergency rooms, at home, on the way to hospitals, and in nursing homes/family wards. This study highlighted the high EWD in some previously unreported groups, indicating new information to facilitate the targeting of necessary preventive measures to those at greatest risk in order to mitigate wintertime death burdens. View Full-Text
Keywords: winter mortality; modify effect; individual characteristic; Cosinor model; case-only analysis winter mortality; modify effect; individual characteristic; Cosinor model; case-only analysis
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He, Y.; Zhang, X.; Ren, M.; Bao, J.; Huang, C.; Hajat, S.; Barnett, A.G. Assessing Effect Modification of Excess Winter Death by Causes of Death and Individual Characteristics in Zhejiang Province, China: A Multi-Community Case-Only Analysis. Int. J. Environ. Res. Public Health 2018, 15, 1663.

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