Winter North Atlantic Oscillation, temperature and ischaemic heart disease mortality in three English counties.

As cold weather is an ischaemic heart disease (IHD) risk factor, year-to-year variations of the level of IHD mortality may be partly determined by inter-annual variations in winter climate. This paper investigates whether there is any association between the level of IHD mortality for three English counties and the winter North Atlantic Oscillation (NAO), which exerts a fundamental control on the nature of the winter climate over Western Europe. Correlation and regression analysis was used to explore the nature of the association between IHD mortality and a climate index (CI) that represents the interaction between the NAO and temperature across England for the winters 1974-1975 to 1989-1999. Statistically significant inverse associations between the CI and the level of IHD mortality were found. Generally, high levels of winter IHD mortality are associated with a negative CI, which represents winters with a strong negative phase of the NAO and anomalously low temperatures across England. Moreover, the nature of the CI in the early stages of winter appears to exert a fundamental control on the general level of winter IHD mortality. Because winter climate is able to explain a good proportion of the inter-annual variability of winter mortality, long-lead forecasting of winter IHD mortality appears to be a possibility. The integration of climate-based health forecasts into decision support tools for advanced general winter emergency service and capacity planning could form the basis of an effective adaptive strategy for coping with the health effects of harsh winters.