Seasonality and coronary heart disease deaths in United States firefighters

Abstract

United States firefighters have a high on-duty fatality rate, and coronary heart disease is the leading cause. Seasonality affects the incidence of cardiovascular events in the general population, but its effects on firefighters are unknown. This study statistically examined the seasonal and annual variation of all on-duty coronary heart disease deaths among US firefighters between 1994 and 2004 using the chi-square distribution and Poisson regression model of the monthly fatality counts. It also examined the effect of ambient temperature (apparent as well as wind chill temperature) on coronary heart disease fatalities during the study span using a time-stratified, case-crossover study design. When grouped by season, we observed the distribution of the 449 coronary heart disease fatalities to show a relative peak in winter (32%) and relative nadir in spring (21%). This pattern was significantly different (p=0.005) from the expected distribution under the null hypothesis of season having no effect. The pattern persisted in additional analyses, stratifying the deaths by the type of duty in which the firefighters were engaged at the time of their deaths. In the Poisson regression model of the monthly fatality counts, the overall goodness-of-fit between the actual and predicted case counts was excellent (chi(4)(2)=16.63; p=0.002). Two distinct peaks were detected: one in January-February and the other in August-September. Overall temperature was not associated with increased risk of on-duty death. After allowing for different effects of temperature in mild/hot versus cold periods, a 1 degrees C increase was not protective in cold weather; nor did it increase the risk of death in warmer weather. The findings of this study reveal statistical evidence for excess coronary heart disease deaths among firefighters during winter; however, the temporal pattern of coronary heart disease deaths was not linked to temperature variation. The seasonal pattern was also found to be independent of duty-related risks.

Figure 1

Distribution of on-duty coronary heart disease deaths among US firefighters. Bars represent actual number of deaths occurring in each calendar month. The dark curve represents the number of deaths predicted by a multivariable Poisson regression model including sine and cosine terms. Legend: y-axis, number of deaths; x-axis, calendar month of death, January through December.

Figure 2

Seasonal Distribution of On-Duty Coronary Heart Disease Deaths among United States Firefighters, by duty type. Legend: y-axis, percent of fatalities; x-axis, season of death. Blue bars represent non-strenuous duty at time of death (non-emergency duty or non-fire emergencies). Green bars represent strenuous duty at time of death (fire suppression, alarm response or return, or physical training).