1 Background 8
2 Excess winter mortality: Monitoring and trends 9
    2.1 Excess winter mortality: 1950–2022 9
    2.2 Excess winter mortality since 2023 11
3 Effects of cold temperatures on mortality 14
4 Causes of winter morbidity and mortality 16
    4.1 Exacerbation of chronic health conditions 16
    Cardiovascular disease 16
    Respiratory disease 16
    Dementia 16
    4.2 Infections 16
    Infections during winter 2024–25 17
    4.3 Hypothermia 20
    4.4 Falls and injuries 20
5 Risk factors for winter mortality 22
    5.1 Demographic factors 22
    Age 22
    Sex 22
    Ethnicity 23
    5.2 Socioeconomic and housing factors 23
    Fuel poverty 23
    Housing characteristics 25
    Rough sleeping and homelessness 26
    5.3 Health status 27
    5.4 Social isolation 27
    5.5 Winter pressures on the NHS 27
6 Geographic variations in winter mortality 28
    6.1 Regional differences in England 28
    6.2 Comparisons across the four parts of the UK 29
    6.3 International comparisons 30
    Limitations with comparisons 30
7 Cold-related vs heat-related mortality 31
8 Impact of climate change on winter mortality 33
    8.1 Temperature-related mortality 33
    8.2 Infections 33
9 Interventions to reduce winter mortality 34
    9.1 Emergency response to cold weather extremes 34
    9.2 Behavioural adaptations 35
    9.3 Vaccination campaigns 36
    Vaccination uptake 39
    9.4 Direct financial support for heating costs 40
    9.5 Energy efficiency and housing interventions 42
    9.6 Identifying vulnerable households and targeting interventions 44
10 Policy considerations 45
References 48
Contributors 59