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Excess mortality related to the August 2003 heat wave in France

Abstract

Objectives: From August 1st to 20th, 2003, the mean maximum temperature in France exceeded the seasonal norm by 11–12°C on nine consecutive days. A major increase in mortality was then observed, which main epidemiological features are described herein. Methods: The number of deaths observed from August to November 2003 in France was compared to those expected on the basis of the mortality rates observed from 2000 to 2002 and the 2003 population estimates. Results: From August 1st to 20th, 2003, 15,000 excess deaths were observed. From 35 years age, the excess mortality was marked and increased with age. It was 15% higher in women than in men of comparable age as of age 45 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality. The geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days. No harvesting effect was observed. Conclusions: Heat waves must be considered as a threat to European populations living in climates that are currently temperate. While the elderly and people living alone are particularly vulnerable to heat waves, no segment of the population may be considered protected from the risks associated with heat waves.

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References

  • Applegate WB, Runyan JW Jr, Brasfield L et al (1981) Analysis of the 1980 heat wave in Memphis. J Am Geriatr Soc 29(8):337–342

    PubMed  CAS  Google Scholar 

  • Bark N (1998) Deaths of psychiatric patients during heat waves. Psychiatr Serv 49(8):1088–1090

    PubMed  CAS  Google Scholar 

  • Basu R, Samet JM (2002) Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev 24(2):190–202

    Article  PubMed  Google Scholar 

  • Besancenot J (2002) Vagues de chaleur et mortalité dans les grandes agglomérations urbaines. Environ Risques Santé 4(1):229–240

    Google Scholar 

  • Braga AL, Zanobetti A, Schwartz J (2002) The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities. Environ Health Perspect 110(9):859–863

    PubMed  Article  Google Scholar 

  • Buechley RW, Van Bruggen J, Truppi LE (1972) Heat island equals death island? Environ Res 5(1):85–92

    Article  PubMed  CAS  Google Scholar 

  • Clarke JF (1972) Some effects of the urban structure on heat mortality. Environ Res 5(1):93–104

    Article  PubMed  CAS  Google Scholar 

  • Conti S, Meli P, Minelli G et al (2005) Epidemiologic study of mortality during the Summer 2003 heat wave in Italy. Environ Res 98(3):390–399

    Article  PubMed  CAS  Google Scholar 

  • Dessai S (2002) Heat stress and mortality in Lisbon part I. Model construction and validation. Int J Biometeorol 47(1):6–12

    Article  PubMed  Google Scholar 

  • Diaz J, Jordan A, Garcia R et al (2002) Heat waves in Madrid 1986–1997: effects on the health of the elderly. Int Arch Occup Environ Health 75(3):163–170

    Article  PubMed  CAS  Google Scholar 

  • Ellis FP, Nelson F (1978) Mortality in the elderly in a heat wave in New York City, August 1975. Environ Res 15(3):504–512

    Article  PubMed  CAS  Google Scholar 

  • Ellis FP, Prince HP, Lovatt G, Whittington RM (1980) Mortality and morbidity in Birmingham during the 1976 heatwave. Q J Med 49(193):1–8

    PubMed  CAS  Google Scholar 

  • Garssen J, Harmsen C, De Beer J (2005) The effect of the summer 2003 heat wave on mortality in the Netherlands. Euro Surveill 10(7)

  • Gover M (1938) Mortality during periods of excessive temperature. Public Health Rep 53:1122–1143

    Google Scholar 

  • Grize L, Huss A, Thommen O, Schindler C, Braun-Fahrlander C (2005) Heat wave 2003 and mortality in Switzerland. Swiss Med Wkly 135(13–14):200–205

    PubMed  Google Scholar 

  • Hajat S, Armstrong BG, Gouveia N, Wilkinson P (2005) Mortality displacement of heat-related deaths: a comparison of Delhi, Sao Paulo, and London. Epidemiology 16(5):613–620

    Article  PubMed  Google Scholar 

  • Hémon D, Jougla E (2003) Surmortalité liée à la canicule d’août 2003: Estimation de la surmortalité et principales caractéristiques épidémiologiques. Inserm. http://www.sante.gouv.fr/htm/actu/surmort_canicule/rapport_complet.pdf

  • Hémon D, Jougla E (2004) Surmortalité liée à la canicule d’août 2003. Suivi de la mortalité 21 Août- 31 Décembre 2003—Causes médicales des décès 1–20 Août 2003. Inserm. http://www.ifr69.vjf.inserm.fr/~webifr/pdf/INSERM_rapport_canicule_octobre2004.pdf

  • Henschel A, Burton LL, Margolies L, Smith JE (1969) An analysis of the heat deaths in St. Louis during July, 1966. Am J Public Health Nations Health 59(12):2232–2242

    PubMed  CAS  Google Scholar 

  • Huynen MM, Martens P, Schram D, Weijenberg MP, Kunst AE (2001) The impact of heat waves and cold spells on mortality rates in the Dutch population. Environ Health Perspect 109(5):463–470

    PubMed  CAS  Google Scholar 

  • InVS (2004) Vague de chaleur de l’été 2003 : relations entre températures, pollution atmosphérique et mortalité dans neuf villes françaises. Rapport d’étude. Département Santé environnement. http://www.invs.sante.fr/publications/2004/psas9_070904/rapport.pdf

  • InVS (2005) Système d’alerte canicule et santé 2005. Rapport opérationnel. Département des maladies chroniques et traumatismes Département Santé environnement. http://www.invs.sante.fr/publications/2005/sacs_2005/rapport_sacs_2005.pdf

  • IPCC (2001) Climate change 2001: synthesis report. A contribution of working groups I, II and III to the 3rd assessment report of the intergovernmental panel on climate change. Cambridge University Press, Cambridge

  • Johnson H, Kovats S, McGregor G et al (2005) The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates. Euro Surveill 10(7)

  • Jones TS, Liang AP, Kilbourne EM et al (1982) Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo. JAMA 247(24):3327–3331

    Article  PubMed  CAS  Google Scholar 

  • Kalkstein LS, Smoyer KE (1993) The impact of climate change on human health: some international implications. Experientia 49(11):969–979

    Article  PubMed  CAS  Google Scholar 

  • Kalkstein LS (2000) Saving lives during extreme weather in summer. BMJ 321(7262):650–651

    Article  PubMed  CAS  Google Scholar 

  • Katsouyanni K, Pantazopoulou A, Touloumi G et al (1993) Evidence for interaction between air pollution and high temperature in the causation of excess mortality. Arch Environ Health 48(4):235–242

    PubMed  CAS  Article  Google Scholar 

  • Kilbourne EM, Choi K, Jones TS, Thacker SB (1982) Risk factors for heatstroke. A case-control study. JAMA 247(24):3332–3336

    Article  PubMed  CAS  Google Scholar 

  • Klinenberg E (1999) Denaturalizing disaster: a social-autopsy of the 1995 Chicago heat wave. Theory Soc 28:239–95

    Article  Google Scholar 

  • Kunst AE, Looman CW, Mackenbach JP (1993) Outdoor air temperature and mortality in the Netherlands: a time-series analysis. Am J Epidemiol 137(3):331–341

    PubMed  CAS  Google Scholar 

  • Livada I, Santamouris M, Niachou K, Papanikolaou N, Mihalakalou G (2002) Determination of places in the great Athens area where the heat island effect is observed. Theor Appl Climatol 71:219–230

    Article  Google Scholar 

  • Matzarakis A, Mayer H (1991) The extreme heat wave in Athens in july 1987 from the point of view of human biometeorology. Atmos Environ 25B:203–211

    Google Scholar 

  • Michelozzi P, de Donato F, Bisanti L et al (2005) The impact of the summer 2003 heat waves on mortality in four Italian cities. Euro Surveill 10(7)

  • Naughton MP, Henderson A, Mirabelli MC et al (2002) Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med 22(4):221–227

    Article  PubMed  Google Scholar 

  • Nogueira PJ, Falcao JM, Contreiras M et al (2005) Mortality in Portugal associated with the heat wave of August 2003: early estimation of effect, using a rapid method. Euro Surveill 10(7)

  • Oechsli FW, Buechley RW (1970) Excess mortality associated with three Los Angeles September hot spells. Environ Res 3(4):277–284

    Article  PubMed  CAS  Google Scholar 

  • Qiu D, Tanihata T, Aoyama H et al (2002) Relationship between a high mortality rate and extreme heat during the summer of 1999 in Hokkaido Prefecture, Japan. J Epidemiol 12(3):254–257

    PubMed  Google Scholar 

  • Rooney C, McMichael AJ, Kovats RS, Coleman MP (1998) Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave. J Epidemiol Commun Health 52(8):482–486

    CAS  Google Scholar 

  • Sartor F, Snacken R, Demuth C, Walckiers D (1995) Temperature, ambient ozone levels, and mortality during summer 1994, in Belgium. Environ Res 70(2):105–113

    Article  PubMed  CAS  Google Scholar 

  • Schär C, Vidale PL, Luthi D et al (2004) The role of increasing temperature variability in European summer heatwaves. Nature 427:332–336

    Article  PubMed  CAS  Google Scholar 

  • Schuman SH (1972) Patterns of urban heat-wave deaths and implications for prevention: data from New York and St. Louis during July, 1966. Environ Res 5(1):59–75

    Article  PubMed  CAS  Google Scholar 

  • 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(2):84–90

    Article  PubMed  CAS  Google Scholar 

  • Shumway RH, Azari AS, Pawitan Y (1988) Modeling mortality fluctuations in Los Angeles as functions of pollution and weather effects. Environ Res 45(2):224–241

    Article  PubMed  CAS  Google Scholar 

  • Simon F, Lopez-Abente G, Ballester E, Martinez F (2005) Mortality in Spain during the heat waves of summer 2003. Euro Surveill 10(7)

  • Smoyer KE (1998) Putting risk in its place: methodological considerations for investigating extreme event health risk. Soc Sci Med 47(11):1809–1824

    Article  PubMed  CAS  Google Scholar 

  • Smoyer KE, Rainham DG, Hewko JN (2000) Heat-stress-related mortality in five cities in Southern Ontario: 1980–1996. Int J Biometeorol 44(4):190–197

    Article  PubMed  CAS  Google Scholar 

  • Whitman S, Good G, Donoghue ER et al (1997) Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health 87(9):1515–1518

    PubMed  CAS  Article  Google Scholar 

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Acknowledgements

We would like to express our gratitude to the institutions that afforded us various forms of assistance in this study: the “Ministère de la Santé, de la Famille et des Personnes Handicapées” which commissioned the present study; Inserm, INSEE and Météo-France, and to the members of those institutions with whom we worked: V. Lasserre, with Inserm-U170-IFR69; C. Jacquart, H. Lefèvre, M. Bovet, F. Péquignot, A. Le Toullec and M. Pauchard, with Inserm-CépiDc-IFR69; G. Desplanques, C. Beaume, F. Clanché, R. Merlen, D. Morineau and L. Doisneau, with INSEE; P. Courtier, B. Rambaldelli, N. Bourdette and J. Manach with Météo-France. We are also very grateful to A. Mullarky for his skilful assistance in the preparation of the English version of this manuscript.

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Correspondence to Denis Hémon.

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A. Fouillet and G. Rey have equally contributed to this work.

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Fouillet, A., Rey, G., Laurent, F. et al. Excess mortality related to the August 2003 heat wave in France. Int Arch Occup Environ Health 80, 16–24 (2006). https://doi.org/10.1007/s00420-006-0089-4

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  • DOI: https://doi.org/10.1007/s00420-006-0089-4

Keywords

  • Heat wave
  • Mortality
  • Modifying factors
  • Causes of death
  • Harvesting