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Excess winter deaths

The most common causes of excess winter deaths are cerebrovascular diseases, ischaemic heart disease and respiratory disease, with the majority of excess winter deaths occurring among older people.  The statistical evidence shows that there is a continuous relationship between indoor temperature and vulnerability to cold-related death. The colder the dwelling, the greater the risk.[1]

In England, there is evidence that colder homes are associated with higher levels of excess winter deaths from cardiovascular disease.  Furthermore, physiological evidence indicates that colder home temperatures can raise blood pressure among some older people, increasing the risk of a cardiovascular event.

Poorly insulated homes and lack of access to mains gas can contribute to fuel poverty; something that has been linked to excess winter deaths.  Herefordshire has a greater proportion of households living in fuel poverty than England as a whole. It also has a much higher proportion of detached and older (pre-1900) housing, which can be relatively poorly insulated and expensive to heat, than England as a whole.  In a 2019 report, BRE found the performance of Herefordshire's housing stock in respect of excess cold hazards to be significantly worse compared to England as a whole (English Housing Survey).[1]

Figure 1: Thematic map showing the proportions of low income households and excess cold (private housing stock) across Herefordshire 

Thematic heat map showing the proportions of low income households and excess cold (private housing stock) across Herefordshire

The excess winter deaths index is calculated as a ratio of deaths occurring over the four month winter period (December to March) compared with the expected number of deaths, based on the average number of deaths observed in the non-winter period.

Between 2001/02 and 2014/15 there has been considerable variability in the number of excess winter deaths in Herefordshire. The lowest number being 22 deaths in 2012/13 and the highest being 225 deaths in 2014/15. Herefordshire’s single year excess winter deaths index has been similar to England’s index from 2001/02 to 2014/15 inclusive.

Figure 1:  Excess winter deaths index (single year) for Herefordshire and England, 2001/02 to 2014/15:

Chart showing the excess winter deaths index (single year) for Herefordshire and England, 2001/02 to 2014/15

Data Source: Public Health England, 2017

In 2014/15 Herefordshire’s excess winter deaths index was significantly higher than that observed in the previous three years. This trend was in line with what was observed nationally. Following statistical investigation, the Office for National Statistics concluded that the observed spike in excess winter deaths in the UK in 2014/15 was largely due to moderate levels of influenza in the community caused by low influenza vaccination effectiveness (34% effectiveness) and the dominant flu strain being influenza A(H3N2), a strain which is particularly virulent in older people. Provisional data for 2015/16 suggests that the national and regional excess winter deaths index were lower, and back in line with average trends.

[1] Housing health and safety rating system (HHSRS) guidance, Office of the Deputy Prime Minister, 2006.

[2] Integrated Dwelling Level Housing Stock Modelling and Database for Herefordshire Council, BRE, 2019.