Multiple deprivation and excess winter deaths in Scotland.

The recent publication of the Scottish Index of Multiple Deprivation (SIMD) has allowed some tentative statistical correlations to be undertaken to assess the impact poverty may have on mortality and morbidity. During the period 1989 to 2001, Scotland registered around 51,600 excess winter deaths (EWDs). An EWD is taken as the additional deaths during December to March than occurred in the preceding and subsequent four-month periods. Almost all of these EWDs were in the population aged over 65. This represents 50 more deaths per day in January than in July. The SIMD measured five criteria by region: income; employment; health and disability; education, skills and training; and geographical access to services. Glasgow was the most deprived region with an SIMD score of 46.88 and East Dunbartonshire, the least deprived region, with a score of 9.07. For the over 65s, the chance of becoming an EWD in Glasgow is one in 36, rising to one in 68 for North Ayrshire. The SIMD is positively correlated with EWD by region (0.35 at the 5% confidence level). This correlation appears to go against the influence of climatic variations, house type, energy efficiency and access to the gas network which favours urban areas. Although some of the additional winter deaths have been ascribed to outdoor cold exposure--exacerbated by inappropriate clothing or culturally determined behaviour--the majority of EWDs are premature and essentially preventable if the elderly can be kept warm in their homes during the winter months.