There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be\r\ndue to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD\r\nmortality rates in all wards in England (1999ââ?¬â??2004) was conducted to estimate the relative strength of the association\r\nbetween CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air\r\nquality. Models were adjusted for deprivation, an index measuring the healthiness of the lifestyle of populations, and\r\nurbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature\r\nand sunshine were both significantly negatively associated (p,0.05), suggesting that CHD mortality rates were higher in\r\nareas with lower average temperature and hours of sunshine. After adjustment for the unhealthy lifestyle of populations\r\nand deprivation, the climate variables explained at least 15% of large scale variation in CHD mortality rates. The results\r\nsuggest that the climate has a small but significant independent association with CHD mortality rates in England.
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