{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:03:12Z","timestamp":1790107392722,"version":"4.0.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dutch Research Council","award":["VI.C.191.019"],"award-info":[{"award-number":["VI.C.191.019"]}],"id":[{"id":"https:\/\/ror.org\/04jsz6e67","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Seasonal fluctuations in mortality significantly affect population health and remain an important public health challenge, particularly in the context of climate change and population ageing. Evidence on how different causes of death shape seasonal mortality patterns remains limited. We apply a novel framework to quantify, in a systematic, transparent, and comparable manner, the absolute and relative contributions of 17 cause-of-death groups to seasonal mortality in Italy. We analyzed monthly mortality data from the Italian National Institute of Statistics, disaggregated by cause of death, sex, and 5-year age groups, 2004\u201319. Excess mortality for 17 major causes of death was quantified by comparing the observed age-standardized death rate (SDR) with the baseline SDR, defined as the average of the 3 months with the lowest mortality each year. Heart and respiratory diseases were the leading contributors to excess mortality, accounting for approximately 40% and 15% of the intra-annual burden, respectively. The summer months exhibited significantly smaller excess mortality. Respiratory diseases showed the highest relative impact compared to the other causes of death. While baseline mortality decreased over time, the relative intra-annual burden remained stable or increased for specific causes, indicating persistent or growing seasonal vulnerabilities. Intra-annual mortality fluctuations in Italy were mainly driven by cardiovascular and respiratory diseases and have remained stable over time despite improvements in overall mortality. These persistent patterns highlight unmet seasonal vulnerabilities and the importance of integrating cause-specific seasonality into health planning, particularly in light of ageing populations and climate change challenges.<\/jats:p>","DOI":"10.1093\/eurpub\/ckag165","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:41:45Z","timestamp":1788522105000},"source":"Crossref","is-referenced-by-count":0,"title":["Analysis of intra-annual mortality fluctuations by cause of death in Italy, 2004\u201319"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9711-2847","authenticated-orcid":false,"given":"Isabella","family":"Marinetti","sequence":"first","affiliation":[{"name":"Max Planck Institute for Demographic Research Laboratory of Demographic Data, , Rostock,","place":["Germany"]},{"name":"Population Research Centre, Faculty of Spatial Sciences, University of Groningen , Groningen,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4633-2011","authenticated-orcid":false,"given":"Dmitri A","family":"Jdanov","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Demographic Research Laboratory of Demographic Data, , Rostock,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6202-8955","authenticated-orcid":false,"given":"France","family":"Mesl\u00e9","sequence":"additional","affiliation":[{"name":"Institut National d\u2018\u00c9tudes D\u00e9mographiques (INED) , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-9292","authenticated-orcid":false,"given":"Domantas","family":"Jasilionis","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Demographic Research Laboratory of Demographic Data, , Rostock,","place":["Germany"]},{"name":"Max Planck\u2014University of Helsinki Center for Social Inequalities in Population Health , Rostock, Germany,","place":["Finland"]},{"name":"Demographic Research Centre, Vytautas Magnus University , Kaunas,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-238X","authenticated-orcid":false,"given":"Fanny","family":"Janssen","sequence":"additional","affiliation":[{"name":"Netherlands Interdisciplinary Demographic Institute, KNAW\/University of Groningen , The Hague,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092215125898000_ckag165-B1","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1136\/jech.57.10.784","article-title":"Excess winter mortality in Europe: a cross country analysis identifying key risk factors","volume":"57","author":"Healy","year":"2003","journal-title":"J Epidemiol Community Health"},{"key":"2026092215125898000_ckag165-B2","first-page":"214","volume-title":"Seasonality in Human Mortality: A Demographic Approach","author":"Rau","year":"2007"},{"key":"2026092215125898000_ckag165-B3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1093\/AJE\/KWJ147","article-title":"Declining vulnerability to temperature-related mortality in London over the 20th century","volume":"164","author":"Carson","year":"2006","journal-title":"Am J Epidemiol"},{"key":"2026092215125898000_ckag165-B4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1136\/oem.2006.029017","article-title":"Heat-related and cold-related deaths in England and Wales: who is at risk?","volume":"64","author":"Hajat","year":"2007","journal-title":"Occup Environ Med"},{"key":"2026092215125898000_ckag165-B5","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1136\/jech-2024-223050","article-title":"Seasonality in mortality and its impact on life expectancy levels and trends across Europe","volume":"79","author":"Marinetti","year":"2025","journal-title":"J Epidemiol Community Health"},{"key":"2026092215125898000_ckag165-B6","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1164\/rccm.200802-217OC","article-title":"High temperature and hospitalizations for cardiovascular and respiratory causes in 12 european cities","volume":"179","author":"Michelozzi","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"key":"2026092215125898000_ckag165-B7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.ijid.2019.08.003","article-title":"Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013\/14\u20132016\/17 seasons)","volume":"88","author":"Rosano","year":"2019","journal-title":"Int J Infect Dis"},{"key":"2026092215125898000_ckag165-B8","doi-asserted-by":"publisher","first-page":"e61720","DOI":"10.1371\/journal.pone.0061720","article-title":"The impact of the February 2012 cold spell on health in Italy using surveillance data. Cayl\u00e0 JA, editor","volume":"8","author":"de\u2019Donato","year":"2013","journal-title":"PLoS One"},{"key":"2026092215125898000_ckag165-B9","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1289\/ehp.1206132","article-title":"Heat, heat waves, and hospital admissions among the elderly in the United States, 1992\u20132006","volume":"122","author":"Gronlund","year":"2014","journal-title":"Environ Health Perspect"},{"key":"2026092215125898000_ckag165-B10","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1136\/jech.46.3.261","article-title":"Seasonal variation in mortality in the Netherlands","volume":"46","author":"Mackenbach","year":"1992","journal-title":"J Epidemiol Community Health"},{"key":"2026092215125898000_ckag165-B11","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1177\/1403494817744074","article-title":"Seasonal variation of cancer mortality in Hungary between 1984 and 2013","volume":"47","author":"Vir\u00e1g","year":"2019","journal-title":"Scand J Public Health"},{"key":"2026092215125898000_ckag165-B12","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1111\/j.1600-0447.2011.01750.x","article-title":"Suicide and seasonality","volume":"125","author":"Christodoulou","year":"2012","journal-title":"Acta Psychiatr Scand"},{"key":"2026092215125898000_ckag165-B13","doi-asserted-by":"publisher","first-page":"531","DOI":"10.3390\/ijerph9020531","article-title":"Seasonality of suicidal behavior","volume":"9","author":"Woo","year":"2012","journal-title":"Int J Environ Res Public Health"},{"key":"2026092215125898000_ckag165-B14","doi-asserted-by":"publisher","first-page":"2256","DOI":"10.3390\/ijerph7052256","article-title":"Surveillance of summer mortality and preparedness to reduce the health impact of heat waves in Italy","volume":"7","author":"Michelozzi","year":"2010","journal-title":"Int J Environ Res Public Health"},{"key":"2026092215125898000_ckag165-B15","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11113-023-09755-5","article-title":"The effect of the great recession on Italian life expectancy","volume":"42","author":"Salinari","year":"2023","journal-title":"Popul Res Policy Rev"},{"key":"2026092215125898000_ckag165-B16","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.envres.2004.10.009","article-title":"Epidemiologic study of mortality during the summer 2003 heat wave in Italy","volume":"98","author":"Conti","year":"2005","journal-title":"Environ Res"},{"key":"2026092215125898000_ckag165-B17","doi-asserted-by":"publisher","DOI":"10.1186\/1476-069X-9-37","article-title":"The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project","volume-title":"Environ Health","author":"D\u2019Ippoliti"},{"key":"2026092215125898000_ckag165-B18","author":"D\u2019Errico","year":"2020"},{"key":"2026092215125898000_ckag165-B19","author":"Michelozzi","year":"2005"},{"key":"2026092215125898000_ckag165-B20","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1002\/clc.20895","article-title":"Seasonal variation in heart failure hospitalization","volume":"34","author":"Gallerani","year":"2011","journal-title":"Clin Cardiol"},{"key":"2026092215125898000_ckag165-B21","doi-asserted-by":"publisher","first-page":"106110","DOI":"10.1016\/j.aap.2021.106110","article-title":"Association between extreme ambient temperatures and general indistinct and work-related road crashes. A nationwide study in Italy","volume":"155","author":"Gariazzo","year":"2021","journal-title":"Accid Anal Prev"},{"key":"2026092215125898000_ckag165-B22","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jad.2006.10.003","article-title":"Seasonality and suicide in Italy: amplitude is positively related to suicide rates","volume":"100","author":"Rocchi","year":"2007","journal-title":"J Affect Disord"},{"key":"2026092215125898000_ckag165-B23","volume-title":"Revision of the European Standard Population: Report of Eurostat\u2019s Task Force\u202f: 2013 Edition","author":"European Commission (Eurostat)","year":"2013"},{"key":"2026092215125898000_ckag165-B24","first-page":"309","article-title":"Sampling variance of standardized mortality rates","volume":"38","author":"Keyfitz","year":"1966","journal-title":"Hum Biol"},{"key":"2026092215125898000_ckag165-B25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s41118-024-00237-w","article-title":"Mortality evolution in Italy: the end of regional convergence?","volume":"80","author":"Carboni","year":"2024","journal-title":"Genus"},{"key":"2026092215125898000_ckag165-B26","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s10680-025-09753-7","article-title":"Seasonal mortality and its impact on spatial inequality in life expectancy across Italy","volume":"41","author":"Marinetti","year":"2025","journal-title":"Eur J Popul"},{"key":"2026092215125898000_ckag165-B27","doi-asserted-by":"publisher","first-page":"e82678","DOI":"10.1371\/journal.pone.0082678","article-title":"Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases","volume":"8","author":"Lin","year":"2013","journal-title":"PLoS One"},{"key":"2026092215125898000_ckag165-B28","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/1471-2261-13-93","article-title":"Association between winter season and risk of death from cardiovascular diseases: a study in more than half a million inpatients in Beijing, China","volume":"13","author":"Xu","year":"2013","journal-title":"BMC Cardiovasc Disord"},{"key":"2026092215125898000_ckag165-B29","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1093\/aje\/kwn266","article-title":"Effects of cold weather on mortality: results from 15 european cities within the PHEWE project","volume":"168","author":"Analitis","year":"2008","journal-title":"Am J Epidemiol"},{"key":"2026092215125898000_ckag165-B30","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/S0140-6736(14)62114-0","article-title":"Mortality risk attributable to high and low ambient temperature: a multicountry observational study","volume":"386","author":"Gasparrini","year":"2015","journal-title":"Lancet"},{"key":"2026092215125898000_ckag165-B31","author":"Ferreira","year":"2025"},{"key":"2026092215125898000_ckag165-B32","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.crvi.2007.12.001","article-title":"Death toll exceeded 70,000 in Europe during the summer of 2003","volume":"331","author":"Robine","year":"2008","journal-title":"C R Biol"},{"key":"2026092215125898000_ckag165-B33","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1038\/s41591-023-02419-z","article-title":"Heat-related mortality in Europe during the summer of 2022","volume":"29","author":"Ballester","year":"2023","journal-title":"Nat Med"},{"key":"2026092215125898000_ckag165-B34","doi-asserted-by":"publisher","first-page":"3101","DOI":"10.1038\/s41591-024-03186-1","article-title":"Heat-related mortality in Europe during 2023 and the role of adaptation in protecting health","volume":"30","author":"Gallo","year":"2024","journal-title":"Nat Med"},{"key":"2026092215125898000_ckag165-B35","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/circulationaha.122.061832","article-title":"Associations between extreme temperatures and cardiovascular cause-specific mortality: results from 27 countries","volume":"147","author":"Alahmad","year":"2023","journal-title":"Circulation"},{"key":"2026092215125898000_ckag165-B36","doi-asserted-by":"publisher","first-page":"e336","DOI":"10.1097\/ee9.0000000000000336","article-title":"Temperature-mortality associations by age and cause: a multi-country multi-city study","volume":"8","author":"Scovronick","year":"2024","journal-title":"Environ Epidemiol"},{"key":"2026092215125898000_ckag165-B37","author":"ISTAT","year":"2023"},{"key":"2026092215125898000_ckag165-B38","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.1016\/S2542-5196(23)00269-3","article-title":"Seasonality of mortality under climate change: a multicountry projection study","volume":"8","author":"Madaniyazi","year":"2024","journal-title":"Lancet Planet Health"},{"key":"2026092215125898000_ckag165-B39","doi-asserted-by":"publisher","DOI":"10.1038\/s43017-022-00371-z"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag165\/71319733\/ckag165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag165\/71319733\/ckag165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:13:03Z","timestamp":1790104383000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckag165\/8828996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckag165","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"ckag165"}}