The Trends in Excess Mortality in Winter vs. Summer in a Sub-Tropical City and Its Association with Extreme Climate Conditions.

While there is literature on excess winter mortality, there are few studies examining the evolution of its trend which may be changing in parallel with global warming. This study aimed to examine the trend in the excess mortality in winter as compared to summer among the older population in a sub-tropical city and to explore its association with extreme weather. We used a retrospective study based on the registered deaths among the older population in Hong Kong during 1976-2010. An Excess Mortality for Winter versus Summer (EMWS) Index was used to quantify the excess number of deaths in winter compared to summer. Multiple linear regressions were used to analyze the trends and its association with extreme weather. Overall, the EMWS Index for ischemic heart disease, cerebrovascular diseases, chronic lower respiratory diseases, pneumonia, and other causes were 43.0%, 34.2%, 42.7%, 23.4% and 17.6%, respectively. Significant decline was observed in the EMWS Index for chronic lower respiratory diseases and other causes. The trend in the index for cerebrovascular diseases depended on the age group, with older groups showing a decline but younger groups not showing any trend. Meteorological variables, in terms of extreme weather, were associated with the trends in the EMWS Index. We concluded that shrinking excess winter mortality from cerebrovascular diseases and chronic lower respiratory diseases was found in a sub-tropical city. These trends were associated with extreme weather, which coincided with global warming.