Archive for the ‘Mortality’ Category

Temperature and Mortality

May 24, 2016

We are all going to die, nothing is surer. “Nobody knows the day or the hour”, but one thing is clear: we are more likely to die in winter than in summer.

Death by unnatural causes (suicide, accident, bushfire, disaster, even acute illness) can come to otherwise healthy people of any age. Death by natural causes is more predictable.

Those vulnerable to death are the elderly, very young babies, those with chronic illness (e.g. asthma, diabetes) and weakened immunity, and those with respiratory and circulatory illness.

Analysing mortality is made difficult because the sample population is always changing. Excess deaths in one month may be followed by further excess deaths in the following month, or because so many vulnerable people have already died, there will be fewer than expected deaths in the next month or months, or even the next couple of winters. Similarly, if fewer than expected deaths occur, there will be a larger cohort of the vulnerable in the following months, getting older and with probably poorer health. Population growth, aging, migration, improved vaccines, and public education programs all play a part as well.

In this analysis, I use mortality and population data from the Australian Bureau of Statistics (ABS), and temperature data from the Bureau of Meteorology (BOM), for Victoria, as it is a small and compact state which is subject to large temperature changes and also severe heat waves. Monthly mortality data are difficult to find, so this study is restricted to the period January 2002 to December 2011. A 10 year period is hardly sufficient for meaningful averages, however some useful insights can be found.

Mortality statistics are available by month, but population figures are by quarter, therefore I interpolated estimated monthly population figures based on three month growth.

Firstly, this plot shows the total deaths for every month from January 2002 to December 2011.

Fig. 1:

act D per mnth
Note the seasonal spikes and dips. The apparent increase in deaths can be compared with Victoria’s population increase:

Fig.2:

Population Vic
By dividing the total deaths by the population in thousands we can calculate the death rate:

Fig. 3:

Death rate per yr

Note the mortality rate has decreased, and that, in spite of heatwaves, bushfires, and flu pandemics, 2009 had a lower death rate than 2008.

Because months have varying numbers of days, a better analysis can be made by calculating the Daily Death Rate for each month (by dividing each monthly rate by 31, 30, 29, or 28 days).

Fig. 4:

mortality per month

For the state of Victoria for the 10 years to 2011, on average more deaths occurred for each day in August than for any other month. The lowest Daily Death Rate was in February.

Now compare with monthly averages (2002 to 2011) for maximum and minimum temperatures:

Fig. 5:

Tmax Tmin avg

The death rate peak lags July temperature by about a month. Cooler months (June to September) are deadlier than warmer (December to April).

The relationship with temperature can be shown with scatter plots:

Fig. 6:

DDR v Tmax

Fig. 7:

DDR v Tmin

Which merely reinforce that deaths are more likely in winter!

Now we look at the question of estimating how many deaths are likely in a given period, by multiplying the average daily death rate for each month by the number of days in each month and by the estimated total population for each month. By subtracting this figure from the actual number of deaths we get a mortality “anomaly”.  The following graph shows this anomaly for each year:

Fig. 8:

Act minus exp deaths per year

And each month:

Fig. 9:

Diff act minus exp Deaths per mnth

Note the peaks in the winters of 2002 and 2003, and also in the summer of 2008-2009. Note also that both graphs show that in spite of a killer heatwave, the Black Saturday bushfire, and the swine flu pandemic, deaths in 2009 were below what could be expected.

To put the anomaly for January 2009 into context, we can compare actual daily deaths per 1,000 population for all months from 2002 to 2011:

Fig. 10:

act daily D per mnth

Note that the extreme figure for January 2009, while extremely high for January, is still below those of the lowest extremes of June, July, and August.

Perhaps higher mortality in the winter months is coincidence and due to some other factor than temperature- seasonal flu incidence for example. I now look at the month of August with the highest average mortality rate:

Fig. 11:

Act minus exp deaths vs Tmin August

There is fairly decent correlation showing that for every degree warmer in minima, the August death toll will be around 150 less than expected.

February, with the lowest rate:

Fig. 12:

Act minus exp deaths vs Tmin Feb

Even in summer, warmer minima mean fewer deaths.

In summer, do higher maxima cause more deaths?

Fig. 13:

Act minus exp deaths vs Tmax Feb

Even including the 173 deaths in the Black Saturday bushfires in the 200 extra deaths for February 2009, there is no trend.

January, whose data include the 2009 heatwave:

Fig. 14:

Act minus exp deaths vs Tmax Jan

A very small trend, but the 2009 heatwave outlier is obvious and skews the data. (Victorian health authorities say there were 374 excess deaths in the week to 1 February 2009).

Extreme heatwaves are indeed killers. Normal hot summers up to two degrees above average are not.

Conclusion:

Improved public health measures, influenza vaccines, and improved public awareness – plus warmer winters- have led to a decrease in the Victorian mortality rate in the period 2002-2011.

Extreme heatwaves are dangerous in Victoria and cause hundreds of extra deaths especially amongst the elderly (>75 years old). However, these are rare events. Severe and Extreme Heatwaves are newsworthy precisely because they are unusual.

Normal Victorian winters are even more dangerous with on average 17.5% more deaths in winter than summer every year, but because this is normal and expected, this regular annual spike in deaths is unremarkable and not newsworthy- much less regarded as a natural disaster. While 374 excess deaths in a week in a heatwave is shocking, even with these included, the highest January’s Daily Death Rate (in 2009) is below that of the lowest of any winter month.

Warmer minimum temperatures are associated with lower death rates at all times of the year, but especially in August in Victoria, where for every degree of extra warmth, about 150 fewer deaths can be expected. I hope, for the sake of those who are sick or elderly, that we have a warm winter this year.

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