Abstract
Background and objective
Climate change leads to more frequent, intense and longer-lasting heat waves which can have severe health outcomes. The elderly are a high-risk population for heat-related mortality and some studies suggested that elderly women are more affected by extreme heat than men. This study aimed to review the presence of sex-specific results in studies performed on mortality in elderly (> 65 years old) after heat waves in Europe.
Methods
A literature search was conducted in July 2017 on papers published in databases Pubmed and Web of Science between January 2000 and December 2016.
Results
68 papers that included mortality data for elderly after heat waves were identified. The 13 of them which presented results distinguished by sex and age group were included in the review. Eight studies showed worse health outcome for elderly women compared to men. One study showed higher mortality rates for men, two found no sex differences and two studies presented inconsistent results.
Conclusion
Studies that present sex-stratified data on mortality after heat waves seem to indicate that elderly women are at higher risk than men. Future research is warranted to validate this finding. Furthermore, a better understanding on the underlying physiological or social mechanisms for possible sex and gender differences in excessive deaths for this vulnerable population is needed to set up appropriate policy measures.
Similar content being viewed by others
References
Anderson BG, Bell ML (2009) Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiol Camb Mass 20:205
Asplund R, Aberg H (1991) Diurnal variation in the levels of antidiuretic hormone in the elderly. J Intern Med 229:131–134
Åström DO, Bertil F, Joacim R (2011) Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies. Maturitas 69:99–105
Atsma F, Bartelink M-LE, Grobbee DE, van der Schouw YT (2006) Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 13:265–279
Austad SN (2006) Why women live longer than men: sex differences in longevity. Gend Med 3:79–92
Baker L, Meldrum KK, Wang M et al (2003) The role of estrogen in cardiovascular disease. J Surg Res 115:325–344
Bao J, Li X, Yu C (2015) The construction and validation of the heat vulnerability index, a review. Int J Environ Res Public Health 12:7220–7234
Basagaña X, Sartini C, Barrera-Gómez J et al (2011) Heat waves and cause-specific mortality at all ages. Epidemiology 22:765–772
Basu R (2009) High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 8:40
Bateson TF, Schwartz J (2004) Who is sensitive to the effects of particulate air pollution on mortality?: a case-crossover analysis of effect modifiers. Epidemiology 15:143–149
Belmin J, Auffray J-C, Berbezier C et al (2007) Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions. Age Ageing 36:298–303
Beniston M, Stephenson DB, Christensen OB et al (2007) Future extreme events in European climate: an exploration of regional climate model projections. Clim Change 81:71–95
Bogdanovic DC, Milosevic ZG, Lazarevic KK et al (2013) The impact of the July 2007 heat wave on daily mortality in Belgrade, Serbia. Cent Eur J Public Health 21:140
Bouchama A, Knochel JP (2002) Heat stroke. N Engl J Med 346:1978–1988
Bouchama A, Dehbi M, Mohamed G et al (2007) Prognostic factors in heat wave-related deaths: a meta-analysis. Arch Intern Med 167:2170–2176
Canoui-Poitrine F, Cadot E, Spira A (2006) Excess deaths during the August 2003 heat wave in Paris, France. Rev Dépidémiologie Santé Publique 54:127–135
Charkoudian N (2003) Skin blood flow in adult human thermoregulation: how it works, when it does not, and why. Mayo Clin Proc 78:603–612
D’Ippoliti D, Michelozzi P, Marino C et al (2010) The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health 9:37
DeCastro M, Gomez-Gesteira M, Ramos AM et al (2011) Effects of heat waves on human mortality, Galicia, Spain. Clim Res 48:333–341
Díaz J, Jordan A, García R et al (2002) Heat waves in Madrid 1986–1997: effects on the health of the elderly. Int Arch Occup Environ Health 75:163–170
Forzieri G, Cescatti A, e Silva FB, Feyen L (2017) Increasing risk over time of weather-related hazards to the European population: a data-driven prognostic study. Lancet Planet Health 1:e200–e208
Fouillet A, Rey G, Laurent F et al (2006) Excess mortality related to the August 2003 heat wave in France. Int Arch Occup Environ Health 80:16–24
Fouillet A, Rey G, Wagner V et al (2008) Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave. Int J Epidemiol 37:309–317
Glazer JL (2005) Management of heatstroke and heat exhaustion. Am Fam Physician 71:2133–2140
Green H, Gilbert J, James R, Byard RW (2001) An analysis of factors contributing to a series of deaths caused by exposure to high environmental temperatures. Am J Forensic Med Pathol 22:196–199
Haines A, Kovats RS, Campbell-Lendrum D, Corvalan C (2006) Climate change and human health: impacts, vulnerability and public health. Public Health 120:585–596. https://doi.org/10.1016/j.puhe.2006.01.002
Hajat S, Armstrong B, Baccini M et al (2006) Impact of high temperatures on mortality: is there an added heat wave effect? Epidemiology 17:632–638
Hajat S, Kovats RS, Lachowycz K (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med 64:93–100
Hansen A, Bi P, Nitschke M et al (2011) Older persons and heat-susceptibility: the role of health promotion in a changing climate. Health Promot J Aust 22:17–20
Holden KC, Smock PJ (1991) The economic costs of marital dissolution: why do women bear a disproportionate cost? Annu Rev Sociol 17:51–78
Hutter H-P, Moshammer H, Wallner P et al (2007) Heatwaves in Vienna: effects on mortality. Wien Klin Wochenschr 119:223–227
IPCC (2014) Climate change 2014: impacts, adaptation, and vulnerability. Part B: regional aspects. In: Barros VR, Field CB, Dokken DJ, Mastrandrea MD, Mach KJ, Bilir TE, Chatterjee M, Ebi KL, Estrada YO, Genova RC, Girma B, Kissel ES, Levy AN, MacCracken S, Mastrandrea PR, White LL (eds) Contribution of working group II to the fifth assessment report of the intergovernmental panel on climate change. Cambridge University Press, Cambridge, UK, p 688
Johnson DP, Stanforth A, Lulla V, Luber G (2012) Developing an applied extreme heat vulnerability index utilizing socioeconomic and environmental data. Appl Geogr 35:23–31
Kannel WB, Hjortland MC, McNamara PM, Gordon T (1976) Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med 85:447–452
Kenney WL (1985) A review of comparative responses of men and women to heat stress. Environ Res 37:1–11
Kenney WL, Craighead DH, Alexander LM (2014) Heat waves, aging, and human cardiovascular health. Med Sci Sports Exerc 46:1891
Klinenberg E (2015) Heat wave: a social autopsy of disaster in Chicago. University of Chicago Press, Chicago
Knochel JP (1989) Heat stroke and related heat stress disorders. Dis Mon DM 35:301–377
Koppe C, Kovats S, Menne B, Jendritzky G et al (2004) Heat-waves: risks and responses. WHO Regional Office for Europe, Copenhagen
Kovats RS, Hajat S (2008) Heat stress and public health: a critical review. Annu Rev Public Health 29:41–55
Kovats RS, Kristie LE (2006) Heatwaves and public health in Europe. Eur J Public Health 16:592–599
Kyselý J, Plavcová E, Davídkovová H, Kynčl J (2011) Comparison of hot and cold spell effects on cardiovascular mortality in individual population groups in the Czech Republic. Clim Res 49:113–129
Leon DA (2011) Trends in European life expectancy: a salutary view. Oxford University Press, Oxford
Le Tertre A, Lefranc A, Eilstein D et al (2006) Impact of the 2003 heatwave on all-cause mortality in 9 French cities. Epidemiology 17:75–79
Li J, Woodward A, Hou X-Y et al (2017) Modification of the effects of air pollutants on mortality by temperature: a systematic review and meta-analysis. Sci Total Environ 575:1556–1570
Mayberry RM, Mili F, Ofili E (2016) Racial and ethnic differences in access to medical care. Med Care Res Rev 57(1_suppl):108–145
Medina-Ramon M, Schwartz J (2008) Who is more vulnerable to die from ozone air pollution? Epidemiology 19:672–679
Meehl GA, Tebaldi C (2004) More intense, more frequent, and longer lasting heat waves in the 21st century. Science 305:994–997
Minson CT, Wladkowski SL, Cardell AF et al (1998) Age alters the cardiovascular response to direct passive heating. J Appl Physiol 84:1323–1332
Naughton MP, Henderson A, Mirabelli MC et al (2002) Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med 22:221–227
O’Neill MS, Carter R, Kish JK et al (2009) Preventing heat-related morbidity and mortality: new approaches in a changing climate. Maturitas 64:98–103. https://doi.org/10.1016/j.maturitas.2009.08.005
Oke TR (1973) City size and the urban heat island. Atmos Environ 1967 7:769–779
Pandolf KB (1997) Aging and human heat tolerance. Exp Aging Res 23:69–105
Pelling M, High C (2005) Understanding adaptation: what can social capital offer assessments of adaptive capacity? Glob Environ Change 15:308–319
Penedo FJ, Dahn JR (2005) Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry 18:189–193
Perkins SE, Alexander LV (2013) On the measurement of heat waves. J Clim 26:4500–4517
Reid CE, O’neill MS, Gronlund CJ et al (2009) Mapping community determinants of heat vulnerability. Environ Health Perspect 117:1730
Rey G, Jougla E, Fouillet A et al (2007) The impact of major heat waves on all-cause and cause-specific mortality in France from 1971 to 2003. Int Arch Occup Environ Health 80:615–626
Rocklöv J, Forsberg B, Ebi K, Bellander T (2014) Susceptibility to mortality related to temperature and heat and cold wave duration in the population of Stockholm County, Sweden. Glob Health Action 7:22737
Rosano G, Vitale C, Marazzi G, Volterrani M (2007) Menopause and cardiovascular disease: the evidence. Climacteric 10:19–24
Sampson NR, Gronlund CJ, Buxton MA et al (2013) Staying cool in a changing climate: reaching vulnerable populations during heat events. Glob Environ Change 23:475–484
Sawka MN, Wenger CB, Pandolf KB (2011) Thermoregulatory responses to acute exercise-heat stress and heat acclimation. Compr Physiol 4:157–186. (Supplement 14: Handbook of Physiology, Environmental Physiology: 157–185. First published in print 1996. doi: 10.1002/cphy.cp040109)
Segar WE, Moore WW (1968) The regulation of antidiuretic hormone release in man. J Clin Invest 47:2143–2151
Selzman CH, Whitehill TA, Shames BD et al (1998) The biology of estrogen-mediated repair of cardiovascular injury. Ann Thorac Surg 65:868–874
Semenza JC, Rubin CH, Falter KH et al (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335:84–90. https://doi.org/10.1056/NEJM199607113350203
Shoenfeld Y, Udassin R, Shapiro Y et al (1978) Age and sex difference in response to short exposure to extreme dry heat. J Appl Physiol 44:1–4
Stafoggia M, Forastiere F, Agostini D et al (2006) Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis. Epidemiology 17:315–323
Tankersley CG, Nicholas WC, Deaver DR et al (1992) Estrogen replacement in middle-aged women: thermoregulatory responses to exercise in the heat. J Appl Physiol 73:1238–1245
United Nations, Department of Economic and Social Affairs, Population Division (2013) World Population Ageing 2013. ST/ESA/SER.A/348
United Nations, Department of Economic and Social Affairs, Population Division (2015) World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241
Utz RL, Carr D, Nesse R, Wortman CB (2002) The effect of widowhood on older adults’ social participation: an evaluation of activity, disengagement, and continuity theories. Gerontologist 42:522–533
Van Den Hombergh CE, Schouten EG, Van Staveren WA et al (1995) Physical activities of noninstitutionalized Dutch elderly and characteristics of inactive elderly. Med Sci Sports Exerc 27:334–339
Vandentorren S, Bretin P, Zeghnoun A et al (2006) August 2003 heat wave in France: risk factors for death of elderly people living at home. Eur J Public Health 16:583–591
van Doorslaer E (2006) Inequalities in access to medical care by income in developed countries. Can Med Assoc J 174(2):177–183
Whitman S, Good G, Donoghue ER et al (1997) Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health 87:1515–1518
Wolf T, McGregor G (2013) The development of a heat wave vulnerability index for London, United Kingdom. Weather Clim Extrem 1:59–68
Wolf J, Adger WN, Lorenzoni I et al (2010) Social capital, individual responses to heat waves and climate change adaptation: an empirical study of two UK cities. Glob Environ Change 20:44–52
World Health Organization (2011) Gender mainstreaming for health managers: a practical approach. World Health Organization, Geneva
Yang X-P, Reckelhoff JF (2011) Estrogen, hormonal replacement therapy and cardiovascular disease. Curr Opin Nephrol Hypertens 20:133–138. https://doi.org/10.1097/MNH.0b013e3283431921
Acknowledgements
This work was supported and funded by the Global Geo Health Data Center, Utrecht University.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Steen, Y., Ntarladima, AM., Grobbee, R. et al. Sex differences in mortality after heat waves: are elderly women at higher risk?. Int Arch Occup Environ Health 92, 37–48 (2019). https://doi.org/10.1007/s00420-018-1360-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-018-1360-1