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Soc Sci Med. 2014 Oct;119:191-7. doi: 10.1016/j.socscimed.2014.01.049. Epub 2014 Jan 31.

Ambient temperature during gestation and cold-related adult mortality in a Swedish cohort, 1915-2002.

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Program in Public Health & Department of Planning, Policy, and Design, University of California at Irvine, United States. Electronic address:
Department of Economics, University of Mannheim, Germany.
School of Public Health, University of California at Berkeley, United States.


For all climatic regions, mortality due to cold exceeds mortality due to heat. A separate line of research indicates that season of birth predicts lifespan after age 50. This and other literature implies the hypothesis that ambient temperature during gestation may influence cold-related adult mortality. We use data on over 13,500 Swedes from the Uppsala Birth Cohort Study to test whether cold-related mortality in adulthood varies positively with unusually benign ambient temperature during gestation. We linked daily thermometer temperatures in Uppsala, Sweden (1915-2002) to subjects beginning at their estimated date of conception and ending at death or the end of follow-up. We specified a Cox proportional hazards model with time-dependent covariates to analyze the two leading causes of cold-related death in adulthood: ischemic heart disease (IHD) and stroke. Over 540,450 person-years, 1313 IHD and 406 stroke deaths occurred. For a one standard deviation increase in our measure of warm temperatures during gestation, we observe an increased hazard ratio of 1.16 for cold-related IHD death (95% confidence interval: 1.03-1.29). We, however, observe no relation for cold-related stroke mortality. Additional analyses show that birthweight percentile and/or gestational age do not mediate discovered findings. The IHD results indicate that ambient temperature during gestation--independent of birth month--modifies the relation between cold and adult mortality. We encourage longitudinal studies of the adult sequelae of ambient temperature during gestation among populations not sufficiently sheltered from heat or cold waves.


Cerebrovascular disorders; Cold spells; Fetal development; Ischemic heart disease; Temperature regulation

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