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Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study.

https://arctichealth.org/en/permalink/ahliterature265383
Source
BMC Med. 2015;13:65
Publication Type
Article
Date
2015
Author
Ailiana Santosa
Joacim Rocklöv
Ulf Högberg
Peter Byass
Source
BMC Med. 2015;13:65
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiovascular Diseases - mortality
Chronic Disease
Cohort Studies
Diabetes Mellitus - mortality
Female
Humans
Male
Middle Aged
Neoplasms - mortality
Respiratory Tract Diseases - mortality
Retrospective Studies
Sweden - epidemiology
Abstract
The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.
A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.
A total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002, and 2003-2006.
Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25?×?25 target, particularly where substantial premature mortality reductions have already been achieved.
Notes
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PubMed ID
25889300 View in PubMed
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Acute fatal effects of short-lasting extreme temperatures in Stockholm, Sweden: evidence across a century of change.

https://arctichealth.org/en/permalink/ahliterature107127
Source
Epidemiology. 2013 Nov;24(6):820-9
Publication Type
Article
Date
Nov-2013
Author
Daniel Oudin Åström
Bertil Forsberg
Sören Edvinsson
Joacim Rocklöv
Author Affiliation
From the aDepartment of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden; bAgeing and Living Conditions Programme, Umeå University, Umeå, Sweden; cCentre for Population Studies, Umeå University, Umeå, Sweden; and dDepartment of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Source
Epidemiology. 2013 Nov;24(6):820-9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Child
Child, Preschool
Extreme Cold - adverse effects
Extreme Heat - adverse effects
Female
Humans
Infant
Male
Middle Aged
Mortality - trends
Risk
Sex Distribution
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.
We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.
Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.
Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.
PubMed ID
24051892 View in PubMed
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Antibodies against cyclic citrullinated peptides of IgG, IgA and IgM isotype and rheumatoid factor of IgM and IgA isotype are increased in unaffected members of multicase rheumatoid arthritis families from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature129227
Source
Ann Rheum Dis. 2012 Jun;71(6):825-9
Publication Type
Article
Date
Jun-2012
Author
Lisbeth Ärlestig
Mohammed Mullazehi
Heidi Kokkonen
Joacim Rocklöv
Johan Rönnelid
Solbritt Rantapää Dahlqvist
Author Affiliation
Department of Public Health, Umeå University, Umeå, Sweden.
Source
Ann Rheum Dis. 2012 Jun;71(6):825-9
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - epidemiology - genetics - immunology
Family
Female
Genetic Predisposition to Disease - epidemiology
Humans
Immunoenzyme Techniques
Immunoglobulin A - blood
Immunoglobulin G - blood
Immunoglobulin M - blood
Isoantibodies - blood
Male
Middle Aged
Peptides, Cyclic - immunology
Predictive value of tests
Rheumatoid Factor - blood
Risk factors
Sensitivity and specificity
Smoking - epidemiology
Sweden - epidemiology
Abstract
Rheumatoid factors (RFs) and antibodies against cyclic citrullinated peptides (CCPs) of IgG, IgA and IgM isotype have been shown to precede disease onset by years.
To evaluate serological risk markers in first-degree relatives from multicase families in relation to genetic and environmental risk factors.
51 multicase families consisting of 163 individuals with rheumatoid arthritis (RA) (mean±SD age, 60±14 years; disease duration 21 years; 71.8% female) and with 157 first-degree relatives unaffected by RA (54±17 years; 59.9% female) were recruited. Isotypes of antibodies against CCPs (IgG, IgA and IgM) and RFs (IgM and IgA) were determined using automated enzyme immunoassays. Cut-off levels were established using receiver operating characteristic curves based on values for 100 unrelated healthy controls.
The concentrations and frequencies of all anti-CCP and RF isotypes were significantly increased in first-degree relatives and patients with RA compared with unrelated healthy controls. The relative distribution of IgA and IgM isotypes was higher than IgG in the relatives, whereas the IgG isotype dominated in patients with RA. The patients carried human leucocyte antigen-shared epitope (HLA-SE) significantly more often than the relatives (71.4% vs 53.9%, p=0.01), while the frequency of the PTPN22 T variant was similar. HLA-SE, combined with smoking, was significantly related to all combinations of anti-CCP and RF isotypes in patients with RA. No such relationships were found for the first-degree relatives.
All anti-CCP and RF isotypes analysed occurred more commonly in unaffected first-degree relatives from multicase families than in controls, but with different isotype distribution from patients with RA.
Notes
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Cites: BMJ. 2002 Feb 2;324(7332):264-611823356
PubMed ID
22128080 View in PubMed
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Association of seasonal climate variability and age-specific mortality in northern Sweden before the onset of industrialization.

https://arctichealth.org/en/permalink/ahliterature260800
Source
Int J Environ Res Public Health. 2014 Jul;11(7):6940-54
Publication Type
Article
Date
Jul-2014
Author
Joacim Rocklöv
Sören Edvinsson
Per Arnqvist
Sara Sjöstedt de Luna
Barbara Schumann
Source
Int J Environ Res Public Health. 2014 Jul;11(7):6940-54
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child, Preschool
Climate
Humans
Industry
Infant
Middle Aged
Mortality - trends
Seasons
Sweden - epidemiology
Weather
Young Adult
Abstract
Little is known about health impacts of climate in pre-industrial societies. We used historical data to investigate the association of temperature and precipitation with total and age-specific mortality in Skellefteå, northern Sweden, between 1749 and 1859.
We retrieved digitized aggregated population data of the Skellefteå parish, and monthly temperature and precipitation measures. A generalized linear model was established for year to year variability in deaths by annual and seasonal average temperature and cumulative precipitation using a negative binomial function, accounting for long-term trends in population size. The final full model included temperature and precipitation of all four seasons simultaneously. Relative risks (RR) with 95% confidence intervals (CI) were calculated for total, sex- and age-specific mortality.
In the full model, only autumn precipitation proved statistically significant (RR 1.02; CI 1.00-1.03, per 1cm increase of autumn precipitation), while winter temperature (RR 0.98; CI 0.95-1.00, per 1 °C increase in temperature) and spring precipitation (RR 0.98; CI 0.97-1.00 per 1 cm increase in precipitation) approached significance. Similar effects were observed for men and women. The impact of climate variability on mortality was strongest in children aged 3-9, and partly also in older children. Infants, on the other hand, appeared to be less affected by unfavourable climate conditions.
In this pre-industrial rural region in northern Sweden, higher levels of rain during the autumn increased the annual number of deaths. Harvest quality might be one critical factor in the causal pathway, affecting nutritional status and susceptibility to infectious diseases. Autumn rain probably also contributed to the spread of air-borne diseases in crowded living conditions. Children beyond infancy appeared most vulnerable to climate impacts.
Notes
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PubMed ID
25003551 View in PubMed
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Attack rates of dengue fever in Swedish travellers.

https://arctichealth.org/en/permalink/ahliterature260850
Source
Scand J Infect Dis. 2014 Jun;46(6):412-7
Publication Type
Article
Date
Jun-2014
Author
Joacim Rocklöv
Wolfgang Lohr
Marika Hjertqvist
Annelies Wilder-Smith
Source
Scand J Infect Dis. 2014 Jun;46(6):412-7
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Bangladesh - epidemiology
Child
Child, Preschool
Dengue - epidemiology
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Sri Lanka - epidemiology
Sweden - epidemiology
Thailand - epidemiology
Travel - statistics & numerical data
Travel Medicine
Young Adult
Abstract
Dengue is endemic in many countries visited by Swedish travellers. We aimed to determine the attack rate of dengue in Swedish travellers and analyse the trends over time and the geographical variation.
We obtained the following data from the Swedish Institute for Communicable Disease Control for the y 1995-2010: number of Swedish residents with confirmed dengue, the country and year of infection. We also obtained registers on the Swedish annual air traveller arrivals to dengue endemic areas from the United Nations World Tourist Organization for the time period. We estimated attack rates with 95% confidence intervals (CI).
In total, 925 Swedish travellers with confirmed dengue were reported. We found an increasing trend over time for most destinations. The majority of the dengue cases were acquired in Thailand (492 out of 925 travellers; 53%), with an attack rate of 13.6 (95% CI 12.7, 14.4) per 100,000 travellers. However, the 2 highest attack rates per 100,000 travellers were found for Sri Lanka (45.3, 95% CI 34.3, 56.4) and Bangladesh (42.6, 95% CI 23.8, 61.5).
Information on attack rates in travellers is more helpful in guiding travel medicine practitioners than reports of absolute numbers, as the latter reflect travel preferences rather than the true risk. Although the majority of dengue infections in Swedish travellers were acquired in Thailand, the attack rates for dengue in travellers to Sri Lanka and Bangladesh were much higher. These data aid in refining information on the risk of dengue in travellers.
PubMed ID
24716463 View in PubMed
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The effect of heat waves on mortality in susceptible groups: a cohort study of a mediterranean and a northern European City.

https://arctichealth.org/en/permalink/ahliterature269401
Source
Environ Health. 2015;14:30
Publication Type
Article
Date
2015
Author
Daniel Oudin Åström
Patrizia Schifano
Federica Asta
Adele Lallo
Paola Michelozzi
Joacim Rocklöv
Bertil Forsberg
Source
Environ Health. 2015;14:30
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cities - epidemiology
Cohort Studies
Diabetes Mellitus - etiology - mortality
Extreme Heat - adverse effects
Female
Heart Failure - etiology - mortality
Humans
Male
Mental Disorders - etiology - mortality
Middle Aged
Mortality
Myocardial Infarction - epidemiology - etiology
Pulmonary Disease, Chronic Obstructive - etiology - mortality
Risk
Rome - epidemiology
Sweden - epidemiology
Abstract
Climate change is projected to increase the number and intensity of extreme weather events, for example heat waves. Heat waves have adverse health effects, especially for the elderly, since chronic diseases are more frequent in that group than in the population overall. The aim of the study was to investigate mortality during heat waves in an adult population aged 50 years or over, as well as in susceptible subgroups of that population in Rome and Stockholm during the summer periods from 2000 to 2008.
We collected daily number of deaths occurring between 15th May and 15th September each year for the population above 50 as well as the susceptible subgroups. Heat wave days were defined as two or more days exceeding the city specific 95th percentile of maximum apparent temperature (MAT). The relationship between heat waves and all-cause non-accidental mortality was investigated through time series modelling, adjusting for time trends.
The percent increase in daily mortality during heat waves as compared to normal summer days was, in the 50+ population, 22% (95% Confidence Interval (CI): 18-26%) in Rome and 8% (95% CI: 3-12%) in Stockholm. Subgroup specific increase in mortality in Rome ranged from 7% (95% CI:-17-39%) among survivors of myocardial infarction to 25% in the COPD (95% CI:9-43%) and diabetes (95% CI:14-37%) subgroups. In Stockholm the range was from 10% (95% CI: 2-19%) for congestive heart failure to 33% (95% CI: 10-61%) for the psychiatric subgroup.
Mortality during heat waves increased in both Rome and Stockholm for the 50+ population as well as in the considered subgroups. It should be evaluated if protective measures should be directed towards susceptible groups, rather than the population as a whole.
Notes
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PubMed ID
25889290 View in PubMed
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The effect of high ambient temperature on the elderly population in three regions of Sweden.

https://arctichealth.org/en/permalink/ahliterature96293
Source
Int J Environ Res Public Health. 2010 Jun;7(6):2607-19
Publication Type
Article
Date
Jun-2010
Author
Joacim Rocklöv
Bertil Forsberg
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 7 Umeå, Sweden. joacim.rocklov@envmed.umu.se
Source
Int J Environ Res Public Health. 2010 Jun;7(6):2607-19
Date
Jun-2010
Language
English
Publication Type
Article
Abstract
The short-term effects of high temperatures are a serious concern in the context of climate change. In areas that today have mild climates the research activity has been rather limited, despite the fact that differences in temperature susceptibility will play a fundamental role in understanding the exposure, acclimatization, adaptation and health risks of a changing climate. In addition, many studies employ biometeorological indexes without careful investigation of the regional heterogeneity in the impact of relative humidity. We aimed to investigate the effects of summer temperature and relative humidity and regional differences in three regions of Sweden allowing for heterogeneity of the effect over the scale of summer temperature. To do so, we collected mortality data for ages 65+ from Stockholm, G?teborg and Sk?ne from the Swedish National Board of Health and Welfare and the Swedish Meteorological and Hydrological Institute for the years 1998 through 2005. In Stockholm and Sk?ne on average 22 deaths per day occurred, while in G?teborg the mean frequency of daily deaths was 10. We fitted time-series regression models to estimate relative risks of high ambient temperatures on daily mortality using smooth functions to control for confounders, and estimated non-linear effects of exposure while allowing for auto-regressive correlation of observations within summers. The effect of temperature on mortality was found distributed over the same or following day, with statistically significant cumulative combined relative risk of about 5.1% (CI = 0.3, 10.1) per degrees C above the 90th percentile of summer temperature. The effect of high relative humidity was statistically significant in only one of the regions, as was the effect of relative humidity (above 80th percentile) and temperature (above 90th percentile). In the southernmost region studied there appeared to be a significant increase in mortality with decreasing low summer temperatures that was not apparent in the two more northerly situated regions. The effects of warm temperatures on the elderly population in Sweden are rather strong and consistent across different regions after adjustment for mortality displacement. The impact of relative humidity appears to be different in regions, and may be a more important predictor of mortality in some areas.
PubMed ID
20644691 View in PubMed
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Environmental Suitability of Vibrio Infections in a Warming Climate: An Early Warning System.

https://arctichealth.org/en/permalink/ahliterature288263
Source
Environ Health Perspect. 2017 10 10;125(10):107004
Publication Type
Article
Date
10-10-2017
Author
Jan C Semenza
Joaquin Trinanes
Wolfgang Lohr
Bertrand Sudre
Margareta Löfdahl
Jaime Martinez-Urtaza
Gordon L Nichols
Joacim Rocklöv
Source
Environ Health Perspect. 2017 10 10;125(10):107004
Date
10-10-2017
Language
English
Publication Type
Article
Keywords
Climate Change - statistics & numerical data
Cross-Over Studies
Environmental Exposure - statistics & numerical data
Humans
Sweden - epidemiology
Vibrio Infections - epidemiology
Abstract
Some Vibrio spp. are pathogenic and ubiquitous in marine waters with low to moderate salinity and thrive with elevated sea surface temperature (SST).
Our objective was to monitor and project the suitability of marine conditions for Vibrio infections under climate change scenarios.
The European Centre for Disease Prevention and Control (ECDC) developed a platform (the ECDC Vibrio Map Viewer) to monitor the environmental suitability of coastal waters for Vibrio spp. using remotely sensed SST and salinity. A case-crossover study of Swedish cases was conducted to ascertain the relationship between SST and Vibrio infection through a conditional logistic regression. Climate change projections for Vibrio infections were developed for Representative Concentration Pathway (RCP) 4.5 and RCP 8.5.
The ECDC Vibrio Map Viewer detected environmentally suitable areas for Vibrio spp. in the Baltic Sea in July 2014 that were accompanied by a spike in cases and one death in Sweden. The estimated exposure-response relationship for Vibrio infections at a threshold of 16°C revealed a relative risk (RR)=1.14 (95% CI: 1.02, 1.27; p=0.024) for a lag of 2 wk; the estimated risk increased successively beyond this SST threshold. Climate change projections for SST under the RCP 4.5 and RCP 8.5 scenarios indicate a marked upward trend during the summer months and an increase in the relative risk of these infections in the coming decades.
This platform can serve as an early warning system as the risk of further Vibrio infections increases in the 21st century due to climate change. https://doi.org/10.1289/EHP2198.
PubMed ID
29017986 View in PubMed
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Increased Risk of Drug-Induced Hyponatremia during High Temperatures.

https://arctichealth.org/en/permalink/ahliterature287798
Source
Int J Environ Res Public Health. 2017 Jul 22;14(7)
Publication Type
Article
Date
Jul-22-2017
Author
Anna K Jönsson
Henrik Lövborg
Wolfgang Lohr
Bertil Ekman
Joacim Rocklöv
Source
Int J Environ Res Public Health. 2017 Jul 22;14(7)
Date
Jul-22-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cross-Over Studies
Drug-Related Side Effects and Adverse Reactions - epidemiology - etiology
Female
Hot Temperature - adverse effects
Humans
Hyponatremia - chemically induced - epidemiology
Linear Models
Male
Middle Aged
Risk
Sweden - epidemiology
Abstract
To investigate the relationship between outdoor temperature in Sweden and the reporting of drug-induced hyponatremia to the Medical Products Agency (MPA).
All individual adverse drug reactions (ADR) reported to MPA from 1 January 2010 to 31 October 2013 of suspected drug-induced hyponatremia and random controls were identified. Reports where the ADR had been assessed as having at least a possible relation to the suspected drug were included. Information on administered drugs, onset date, causality assessment, sodium levels, and the geographical origin of the reports was extracted. A case-crossover design was used to ascertain the association between heat exposure and drug-induced hyponatremia at the individual level, while linear regression was used to study its relationship to sodium concentration in blood. Temperature exposure data were obtained from the nearest observation station to the reported cases.
During the study period, 280 reports of hyponatremia were identified. More cases of drug-induced hyponatremia were reported in the warmer season, with a peak in June, while other ADRs showed an opposite annual pattern. The distributed lag non-linear model indicated an increasing odds ratio (OR) with increasing temperature in the warm season with a highest odds ratio, with delays of 1-5 days after heat exposure. A cumulative OR for a lag time of 1 to 3 days was estimated at 2.21 at an average daily temperature of 20 °C. The change in sodium per 1 °C increase in temperature was estimated to be -0.37 mmol/L (95% CI: -0.02, -0.72).
Warm weather appears to increase the risk of drug-induced hyponatremia.
Notes
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PubMed ID
28737683 View in PubMed
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The influence of seasonal climate variability on mortality in pre-industrial Sweden.

https://arctichealth.org/en/permalink/ahliterature114952
Source
Glob Health Action. 2013;6:20153
Publication Type
Article
Date
2013
Author
Barbara Schumann
Sören Edvinsson
Birgitta Evengård
Joacim Rocklöv
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden. barbara.schumann@epiph.umu.se
Source
Glob Health Action. 2013;6:20153
Date
2013
Language
English
Publication Type
Article
Keywords
Climate
History, 18th Century
History, 19th Century
Humans
Mortality - history - trends
Seasons
Socioeconomic Factors
Sweden - epidemiology
Weather
Abstract
Recent studies have shown an association between weather and climatic factors with mortality, cardiovascular and infectious diseases. We used historical data to investigate the impact of seasonal temperature and precipitation on total mortality in Uppsala, Sweden, during the first two stages of the demographic transition, 1749-1859.
We retrieved mortality and population numbers of the Uppsala Domkyrka parish from digitised parish records and obtained monthly temperature and precipitation measures recorded in Uppsala during that time. Statistical models were established for year-to-year variability in deaths by annual and seasonal temperature and precipitation, adjusting for longer time trends. In a second step, a model was established for three different periods to study changes in the association of climate variability and mortality over time. Relative risks (RR) with 95% confidence intervals (CI) were calculated.
Precipitation during spring and autumn was significantly associated with annual mortality (spring RR 0.982, CI 0.965-1.000; autumn RR 1.018, CI 1.004-1.032, respectively, per centimetre increase of precipitation). Higher springtime temperature decreased annual mortality, while higher summer temperature increased the death toll; however, both were only borderline significant (p=0.07). The significant effect of springtime precipitation for mortality was present only in the first two periods (1749-1785 and 1786-1824). On the contrary, the overall effect of autumn precipitation was mainly due to its relevance during the last period, 1825-1859 (RR 1.024, CI 0.997-1.052). At that time, higher winter precipitation was found to decrease mortality.
In urban Uppsala, during the 18th and 19th century, precipitation appeared to be a stronger predictor for mortality than temperature. Higher spring precipitation decreased and higher autumn precipitation increased the number of deaths. However, this association differed before and during the early stages of industrialisation. Further research shall take age-specific differences into account, as well as changes in socio-economic conditions during that time.
Notes
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PubMed ID
23561027 View in PubMed
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