The decline in winter excess mortality in The Netherlands

Area of Science:

• Public Health
• Epidemiology
• Demography

Background:

• Winter excess mortality is a recognized phenomenon in many countries.
• Recent decades have seen a decline in this seasonal increase in deaths.
• The underlying causes for this decline remain largely unknown.

Purpose of the Study:

• To investigate trends in winter excess mortality in the Netherlands from 1953-1988.
• To identify potential factors contributing to the observed decline.
• To formulate hypotheses regarding the causes of reduced winter mortality.

Main Methods:

• Analysis of death records by age, cause, and month of death (1953-1988).
• Utilized log-linear regression to analyze mortality trends.
• Examined changes in winter excess mortality with and without influenza epidemics.

Main Results:

• A 50% reduction in winter excess mortality occurred between the 1950s and 1970, with a smaller subsequent decline.
• Declines in cardiovascular and respiratory diseases largely explain the reduction in total winter mortality.
• Reduced excess mortality was observed in both epidemic and non-epidemic winter months.

Conclusions:

• Influenza-associated mortality reduction explains only part of the decline in winter excess mortality.
• The impact of central heating introduction is considered minimal.
• Socioeconomic progress is suggested as a fundamental factor driving the reduction in winter excess mortality.