Outdoor clothing: its relationship to geography, climate, behaviour and cold-related mortality in Europe.

It has been suggested, that the inhabitants of northern European regions, who experience little cold-related mortality, protect themselves outdoors by wearing more clothing, at the same temperature, than people living in southern regions where such mortality is high. Outdoor clothing data were collected in eight regions from 6583 people divided by sex and age group (50-59 and 65-74 years). Across Europe, the total clothing worn (as assessed by dry thermal insulation and numbers of items or layers) increased significantly with cold, wind, less physical activity and longer periods outdoors. Men wore 0.14 clo (1 clo = 0.115 m2 K W-1) more than women and the older people wore 0.05 clo more than the younger group (both P < 0.001). After allowance for these factors, regional differences in insulation and item number were correlated (r = -0.74, P = 0.037; r = -0.74, P = 0.036 respectively), but not those in clothing layers (r = -0.21; P = 0.61), with indices of cold-related mortality. Cold weather most increased the wearing of gloves, scarves and hats. The geographical variation in the wearing of these three together items more closely matched that in cold-related mortality (r = -0.89, P = 0.003). A possible explanation for this may be that they protect the head and hands, where stimulation by cold greatly increases peripheral vasoconstriction causing a rise in blood pressure that procedure haemoconcentration and raised cardiovascular risk.