Winter mortality in elderly people in Britain
http://www.100md.com
《英国医生杂志》
EDITOR—Keatinge and Donaldson and Woodall point out the important evidence that winter and cold-related mortality may be caused by outdoor exposures to cold. We strongly support their view that to date public health strategies to reduce winter mortality have paid insufficient attention to reducing outdoor cold stress.
However, our study on winter death in elderly people should not be interpreted as providing evidence against indoor temperatures as important. The results have little bearing on this and are entirely compatible with indoor cold as an important or even dominant factor. Inadequate home heating remains a probable key determinant of winter death.
Our conclusion that tackling fuel poverty may be insufficient reflects the simple observation that the risk of excess winter death seems to be widespread, and not simply concentrated in the poorer socioeconomic groups targeted by fuel poverty strategies. Intuitively, a lack of socioeconomic gradient might seem contrary to the expected distribution of cold homes, but it is in fact consistent with limited evidence that low indoor temperatures are not confined to poor households.1 Cold exposure through such activities as standing at an unshielded bus stop might also be expected to have a socioeconomic gradient, so the lack of one, which Rau also reports in an analysis of Danish data, points to a more complex distribution of risk.
Woodall's conjectures on the importance of windchill and the activity patterns of women are interesting, and remind us that there remain many questions about determinants and mechanisms.
Paul Wilkinson, senior lecturer
London School of Hygiene and Tropical Medicine, London WC1E 7HT Paul.Wilkinson@lshtm.ac.uk
Competing interests: None declared.
References
Wilkinson P, Landon M, Armstrong B, Stevenson S, McKee M. Cold comfort: the social and environmental determinants of excess winter death in England, 1986-1996. York: Joseph Rowntree Foundation, 2001.
However, our study on winter death in elderly people should not be interpreted as providing evidence against indoor temperatures as important. The results have little bearing on this and are entirely compatible with indoor cold as an important or even dominant factor. Inadequate home heating remains a probable key determinant of winter death.
Our conclusion that tackling fuel poverty may be insufficient reflects the simple observation that the risk of excess winter death seems to be widespread, and not simply concentrated in the poorer socioeconomic groups targeted by fuel poverty strategies. Intuitively, a lack of socioeconomic gradient might seem contrary to the expected distribution of cold homes, but it is in fact consistent with limited evidence that low indoor temperatures are not confined to poor households.1 Cold exposure through such activities as standing at an unshielded bus stop might also be expected to have a socioeconomic gradient, so the lack of one, which Rau also reports in an analysis of Danish data, points to a more complex distribution of risk.
Woodall's conjectures on the importance of windchill and the activity patterns of women are interesting, and remind us that there remain many questions about determinants and mechanisms.
Paul Wilkinson, senior lecturer
London School of Hygiene and Tropical Medicine, London WC1E 7HT Paul.Wilkinson@lshtm.ac.uk
Competing interests: None declared.
References
Wilkinson P, Landon M, Armstrong B, Stevenson S, McKee M. Cold comfort: the social and environmental determinants of excess winter death in England, 1986-1996. York: Joseph Rowntree Foundation, 2001.