The Role of Age in the UK’s Excess Winter Mortality Problem: A Systematic Review
Abstract
Introduction: The United Kingdom exhibits higher excess winter mortality (EWM) than comparable high-income European countries, despite milder winters. Although older adults (≥65 years) bear the greatest mortality burden, age is rarely analysed as a stratified or modifying factor in EWM research. This systematic review synthesises existing evidence (published 2000 to April 2026) on the relationship between age and EWM in the UK.
Methods: We conducted a systematic search of MEDLINE, Web of Science, Embase, and CINAHL, supplemented by reference list hand searching. Twenty-five studies met inclusion criteria (12 peer-reviewed and 13 reports). Meta-analysis was not feasible due to heterogeneity in EWM definitions and outcome measures. Most studies (n = 21) relied on Office of National Statistics data. A narrative synthesis was undertaken to integrate findings. Study quality was appraised using the Joanna Briggs Institute tools.
Results: EWM in the UK has generally declined since 1955, although recent trends show volatility, partly attributed to the COVID-19 pandemic. All included studies identified age as a major risk factor. The highest mortality burden is observed among the oldest age groups (≥85) and among older women. Lower temperatures are consistently associated with increased EWM, with disproportionately stronger effects in older adult populations.
Discussion: Despite age being a salient risk factor, age-disaggregated EWM analysis was limited, suggesting that it is often treated as a background characteristic rather than an analytically interrogated determinant. This may reflect unintentional ageism. More granular data, detailed age stratification and modelling of interactions with temperature and socioeconomic factors are needed to clarify whether risk increases progressively across the life course. Improved reporting of cause-specific mortality, sex, and socioeconomic status would strengthen inference and support targeted public health interventions to prevent EWM.
Key messages: • Older age, especially among ≥85 or women, is consistently associated with higher excess winter mortality in the UK, yet age is rarely analysed beyond broad categories in existing studies.
• More granular, age-stratified data and improved reporting are needed to clarify life-course risk patterns and better target interventions for excess winter mortality.
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BibTeX
@article{champagne2026role,
title = {{The Role of Age in the UK’s Excess Winter Mortality Problem: A Systematic Review}},
author = {SN Champagne and C Brack and J Tanner and AM Guntupalli},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.168},
url = {https://doi.org/10.1093/eurpub/ckag169.168},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The Role of Age in the UK’s Excess Winter Mortality Problem: A Systematic Review
AU - SN Champagne
AU - C Brack
AU - J Tanner
AU - AM Guntupalli
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.168
UR - https://doi.org/10.1093/eurpub/ckag169.168
AB - Introduction: The United Kingdom exhibits higher excess winter mortality (EWM) than comparable high-income European countries, despite milder winters. Although older adults (≥65 years) bear the greatest mortality burden, age is rarely analysed as a stratified or modifying factor in EWM research. This systematic review synthesises existing evidence (published 2000 to April 2026) on the relationship between age and EWM in the UK. Methods: We conducted a systematic search of MEDLINE, Web of Science, Embase, and CINAHL, supplemented by reference list hand searching. Twenty-five studies met inclusion criteria (12 peer-reviewed and 13 reports). Meta-analysis was not feasible due to heterogeneity in EWM definitions and outcome measures. Most studies (n = 21) relied on Office of National Statistics data. A narrative synthesis was undertaken to integrate findings. Study quality was appraised using the Joanna Briggs Institute tools. Results: EWM in the UK has generally declined since 1955, although recent trends show volatility, partly attributed to the COVID-19 pandemic. All included studies identified age as a major risk factor. The highest mortality burden is observed among the oldest age groups (≥85) and among older women. Lower temperatures are consistently associated with increased EWM, with disproportionately stronger effects in older adult populations. Discussion: Despite age being a salient risk factor, age-disaggregated EWM analysis was limited, suggesting that it is often treated as a background characteristic rather than an analytically interrogated determinant. This may reflect unintentional ageism. More granular data, detailed age stratification and modelling of interactions with temperature and socioeconomic factors are needed to clarify whether risk increases progressively across the life course. Improved reporting of cause-specific mortality, sex, and socioeconomic status would strengthen inference and support targeted public health interventions to prevent EWM. Key messages: • Older age, especially among ≥85 or women, is consistently associated with higher excess winter mortality in the UK, yet age is rarely analysed beyond broad categories in existing studies. • More granular, age-stratified data and improved reporting are needed to clarify life-course risk patterns and better target interventions for excess winter mortality.
SN - 1101-1262
SN - 1464-360X
ER -