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Excess Winter Deaths

Introduction

Reading has a higher rate of excess winter deaths than both the national average and the average amongst Local Authorities with similar levels of deprivation. However, since the number of deaths used for this calculation at Local Authority level is small, confidence in these data to demonstrate significant differences is limited. 

2014/15 saw a national increase in the number of excess winter deaths, with the biggest increases amongst men under 85 and women over 85. The rate of excess winter deaths in Reading has continued to fall closer to the national average in 2014/15, but the rate amongst women increased to above the national average between 2010-13 and 2011-14.   

What do we know?

Cold weather in the UK is associated with increase in death and ill health from heart attack, stroke, lung diseases, flu and other conditions, as well as injuries from falls in icy or snowy conditions and hypothermia. In recent years there have typically been between 18,000 and 25,000 additional deaths in England between December and March, a higher rate than seen in some colder Northern European countries (PHE, 2015; NICE, 2015), but the number was much higher in 2014/15 - reaching 43,900 deaths (see Figure 1, below).

Figure 1: Number of excess winter deaths and five year central moving average, England and Wales (1950/51 - 2014/15)

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Figure 1

Source: Office for National Statistics

Most winter deaths are caused by respiratory and cardiovascular problems at normal winter temperatures. Although risks increase as the temperature falls further (NICE, 2015), the link between average winter temperature and mortality is not straightforward (ONS, 2015). For example, although the winter of 2009/10 was usually cold, the number of winter deaths fell in comparison to the previous year (see Figure 2, below). Some analysis suggests that, as cold weather may occur outside of the designated 'winter months' (December to March) it may be difficult to observe any correlation between cold weather and high mortality rates using this standard measure (NICE, 2015). 

Figure 2: Number of excess winter deaths and average winter temperature, England and Wales (1999/2000 - 2014/15)

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Figure 2

Source: Office for National Statistics

Although there is agreement that influenza incidence influences excess winter deaths, there is some divergence between authorities on this complex relationship (ONS, 2015; NICE, 2015). 

Facts, Figures, Trends

The Excess Winter Death (EWD) index calculates the number of winter deaths (deaths that occur between December and March compared to the expected number of deaths in a four month period), and expresses it as a percentage of the total number of expected deaths. The EWD for Reading for all ages for 2011-2014 was 19.1. This is higher than both the national average of 15.6 and the average amongst Local Authorities with similar levels of deprivation of 14.7. Since the number of deaths used for this calculation at Local Authority level is small, confidence in these data to demonstrate significant differences is limited. Figure 3 (below) is taken from the Public Health Outcomes Framework and shows the wide confidence intervals for each Local Authority area. 

Figure 3: Excess Winter Deaths (EWD) Index - Public Health Outcomes Framework Indicator

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Figure 3

Source: Public Health Outcomes Framework, indicator 4.15iii

Reading's overall rate of EWD over time shows an improving picture: Figure 4, below, demonstrates a narrowing gap between EWD rate in Reading and the national average and the average amongst Local Authorities with similar levels of deprivation. 

Figure 4: Excess Winter Deaths in Reading 2006-2014

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Figure 4

Source: Public Health Outcomes Framework 

The picture for older age groups is similar, with EWD decreasing until 2010-2013; however the most recent data shows a levelling out in 2011-2014 (Figure 5). 

Figure 5: Excess Winter Deaths in those aged 85+ in Reading 2006-2014

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Figure 5

Source: Public Health Outcomes Framework

Analysis of the EWD index by gender suggests differences in trends for men and women. While EWD rate amongst men in Reading has continued to narrow towards the national average, the rate for women fell in line with the national average between 2010 and 2013, but has increased to above average levels in 2011-2014. 

A similar trend can be observed just amongst those aged 85+, where the rate of EWD is higher. This increase in winter mortality rate among older women is likely to have resulted in the levelling effect seen in the overall local rate in the last three year period. 
Nationally, the greatest increase in deaths 2014-15 was seen in males under 85, followed by women aged 85 and over (ONS, 2015). 

Figure 6: Excess Winter Deaths by Gender (all ages)

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Figure 6

Source: Public Health Outcomes Framework

Figure 7: Excess Winter Deaths by Gender (85+)

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Figure 7

Source: Public Health Outcomes Framework

Analysis of EWDs by cause of death shows an increase in three major underlying causes of death, of which the greatest seasonal effect was seen in deaths related to dementia and Alzheimer's disease (see Figure 8). These may be related to additional difficulties with self-care or vulnerability to other conditions and to falls and injuries. A change to the way in which diseases are recorded may account for some of this increase (ONS, 2015). Since the proportion of EWDs related to dementia and Alzheimer's disease is higher amongst women, this may also have had an effect on the increase in EWDs in women seen locally. 

Figure 8: Excess Winter Deaths Index by underlying cause of death, England and Wales, 2012/13 - 2014/15

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Figure 8

Source: Public Health Outcomes Framework

What are the key inequalities?

NICE (2015) highlight certain groups who may be more vulnerable to the effects of the cold or to having cold homes, including those who are homeless or living in non-typical housing such as caravans or mobile homes, those with disabilities or other pre-existing conditions, recent immigrants and some minority ethnic groups who are more vulnerable to deprivation. 

What are the unmet needs/ service gaps?

More work is needed to fully understand the drivers behind excess winter deaths in Reading, but local data suggests that older women, including those with existing conditions such as dementia and Alzheimer's disease, may be at high risk. Continuing to support front line services working with these groups to be aware of the risks of cold weather may help to reduce the local rate of EWD.

Local and National Strategies

PHE's 'Cold Weather Plan' (2015) emphasises the need for planning for the burden of ill-health at moderate winter temperatures, including awareness of the needs of those most at risk. 

NICE guidelines (2015) make recommendations on how to reduce the risk of death and ill health associated with living in a cold home with the wider aims of reducing preventable excess winter death rates; improving health and wellbeing among vulnerable groups; reducing pressure on health and social care services; reducing 'fuel poverty' and the risk of fuel debt or being disconnected from gas and electricity supplies; and improving the energy efficiency of homes. The guidance recommends strategic planning to help ensure that homes are properly insulated and heated. 

Reading Borough Council's Winter Watch programme, run in partnership with key local voluntary and health sector partners, operates between December and March and provides support to vulnerable residents to heat and insulate their homes. There are also a number of events to raise awareness.

Local implementation of immunisation against influenza in Reading has been successful. Rates amongst Reading CCGs are higher than national and regional averages for all high-risk groups (see table 1, below.) 

Table 1: Immunisation against influenza by CCG and National and Regional averages

CCG>646mo- 65 at riskPregnant womenAll 2 y/oAll 3 y/oAll 4 y/o
N&W Reading77.657.456.247.452.339.0
South Reading73.253.845.240.742.036.1
Thames Valley73.952.147.544.447.036.6
England72.350.344.1   

Source: Local CCG Performance Data

This section links to the following sections in the JSNA: 

Dementia

Common causes of death and disability

Deprivation by ward and lower super output area

Gypsies and travellers

Respiratory conditions

Cardiovascular disease

References

National Institute for Clinical Excellence (NICE), 2015. Excess winter deaths and illness and the health risks associated with cold homes. NICE guidelines [NG6]. NICE, London. 

Office for National Statistics (ONS), 2015. Excess Winter Mortality in England and Wales: 2014/15 Provisional and 2013/14 (Final). http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/excesswintermortalityinenglandandwales/201415provisionaland201314final#excess-winter-mortality-ewm-by-sex-and-age

Public Health England, 2015. The Cold Weather Plan for England: Protecting health and reducing harm from cold weather. PHE, Local Government Association, Met Office. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/468160/CWP_2015.pdf [Accessed 17th May 2016]. 

 

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