Excess winter deaths in 30 European countries 1980-2013: a critical review of methods

Background Extreme temperatures (both excess heat and excess cold) are associated with elevated mortality risk. Methods and Results This article reviews historical data on cold-related deaths in Europe (1980-2013). It outlines the classic 'excess winter deaths' methodology used to estimate cold-related mortality and explores the inaccuracies that are associated with this generic estimation method: it yields relatively accurate estimates of the actual public health impacts of cold temperatures in only 2 of 30 European countries. This is an issue of concern, given the prominent role of excess winter deaths monitoring in public health policymaking and research. An alternative estimation method is proposed, based on heating degree days, which could yield more accurate estimations of the public health implications of cold weather in Europe, and how these vary across different countries. Conclusions Further research is needed to scrutinize core assumptions underlying excess winter death methodology, particularly as to whether it has equal validity for estimating public health impacts across the widely diverse climatic conditions that prevail across Europe. In the meantime, given data on heating degree days are freely available for European countries, it is recommended that this approach replaces the conventional methodology.