Winter mortality and cold stress in Yekaterinburg, Russia: interview survey
Authors: G C Donaldson, V E Tchernjavskii, S P Ermakov, K Bucher, W R Keatinge
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objectives:</b> To evaluate how mortality and protective measures against exposure to cold change as temperatures fall between October and March in a region of Russia with a mean winter temperature below −6 °C. <b>Design:</b> Interview to assess factors associated with cold stress both indoors and outdoors, to measure temperatures in living room, and to survey unheated rooms. <b>Setting:</b> Sverdlovsk Oblast (district), Yekaterinburg, Russia. <b>Subjects:</b> Residents aged 50–59 and 65–74 living within approximately 140 km of Yekaterinburg in Sverdlovsk Oblast. Survey of sample of 1000 residents equally distributed by sex and age groups. <b>Main outcome measures:</b> Regression analysis was used to relate data on indoor heating and temperatures, the amount of clothing worn, the amount of physical activity, and shivering while outside, to outdoor temperature; results were compared with mortality patterns for ischaemic heart disease, cerebrovascular disease, respiratory disease, and mortality from all causes. <b>Results:</b> As mean daily temperatures fell to 0°C the amount of clothing worn outdoors increased, physical activity while outdoors became more continuous, and only 11 (6.6%) of the 167 people surveyed who went outdoors at temperatures above 0°C reported shivering. The mean temperature in living rooms in the evening remained above 21.9°C. Mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes did not change. As the temperature fell below 0°C the number of items of clothing worn plateaued at 16.0 and the number of layers at 3.7. With regression analysis, shivering outdoors was found to increase progressively to 34.6% (P&lt;0.001) of excursions at −25°C, and mortality (after declining slightly) rose progressively (all cause mortality rose by 1.15% for each 1°C drop in temperature from 0°C to −29.6°C, 95% confidence interval 0.97% to 1.32%). 94.2% of bedrooms were directly heated, and evening temperatures in the living room averaged 19.8°C even when outside temperatures reached −25°C. <b>Conclusions:</b> Outdoor cold stress and mortality in Yekaterinburg increased only when the mean daily temperature dropped below 0°C. At temperatures down to 0°C cold stress and excess mortality were prevented by increasing the number of items of clothing worn and the amount of physical activity outdoors in combination with maintaining warmth in houses. <h3>Key messages</h3> There was no increase in mortality in the population of an industrialised region of western Siberia as the temperature fell to 0°C; in western Europe the same fall in temperature is associated with large increases in mortality Warm clothing and physical activity prevented cold stress outdoors and warm housing prevented cold stress indoors These results suggest that the high excess winter mortality in western Europe could be prevented by people wearing sufficient clothing and engaging in physical activity outdoors, and by adequately heating houses