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Rurality, deprivation, and excess winter mortality: an ecological study
  1. D A Lawlor,
  2. R Maxwell,
  3. B W Wheeler
  1. Department of Social Medicine, University of Bristol, Bristol UK
  1. Correspondence to:
 Dr D Lawlor, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK;

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The reasons for the higher levels of excess winter mortality in Britain, compared with countries with colder winters, are unclear. Ecological studies suggest that both increased outdoor and indoor cold exposure relating to poor housing energy efficiency and lack of adequate clothing and physical activity when outdoors are important.1,2 It seems plausible that excess winter mortality would be greater in more deprived areas as deprived populations are more likely to live in poor quality energy inefficient housing and are less likely to be car owners. Two British studies have found no association between area deprivation and excess winter mortality, but both were based in single district health authorities and may not have had the power to detect an association.3,4 Furthermore, both studies were based in urban areas and were unable to assess the association between excess winter mortality and rurality.

It has been suggested that rural areas in Britain are at increased risk of excess winter mortality and that government action should be targeted at these areas. A range of features—poor quality housing, high proportion of detached houses, lack of access to gas networks, and low take up of government energy efficiency grants—may make rural populations vulnerable to indoor cold exposure. Outdoor occupations and poor public transport systems in rural areas may increase outdoor cold exposure.

The aim of this study was to assess the association between both rurality, and area deprivation, and excess winter mortality in a large region …

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  • Funding: funding for the special ONS tape with mortality data by month was provided by South West Region NHS executive. The views expressed in this paper are those of the authors and not necessarily those of the South West NHS executive.

  • Conflicts of interest: none.