The August 2003 heat wave in France resulted in many thousands of excess deaths particularly of elderly people. Individual and environmental risk factors for death among the community-dwelling elderly were identified. We conducted a case–control survey and defined cases as people aged 65 years and older who lived at home and died from August 8 through August 13 from causes other than accident, suicide, or surgical complications. Controls were matched with cases for age, sex, and residential area. Interviewers used questionnaires to collect data. Satellite pictures provided profiles of the heat island characteristics around the homes. Lack of mobility was a major risk factor along with some pre-existing medical conditions. Housing characteristics associated with death were lack of thermal insulation and sleeping on the top floor, right under the roof. The temperature around the building was a major risk factor. Behaviour such as dressing lightly and use of cooling techniques and devices were protective factors. These findings suggest people with pre-existing medical conditions were likely to be vulnerable during heat waves and need information on how to adjust daily routines to heat waves. In the long term, building insulation and urban planning must be adapted to provide protection from possible heat waves.

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

Aims and Methods:Long term effects of air pollution on mortality were studied in 14 284 adults who resided in 24 areas from seven French cities when enrolled in the PAARC survey (air pollution and chronic respiratory diseases) in 1974. Daily measurements of sulphur dioxide, total suspended particles, black smoke, nitrogen dioxide, and nitric oxide were made in 24 areas for three years (1974–76). Cox proportional hazards models controlling for individual confounders (smoking, educational level, body mass index, occupational exposure) were applied, and frailty models used to take into account spatial correlation. Indicators of air pollution were the mean concentration.Results:Models were run before and after exclusion of six area monitors influenced by local traffic (NO/NO₂>3 in ppb). After exclusion of these areas, analyses showed that adjusted risk ratios (95% CI) for TSP, BS, NO₂, and NO for non-accidental mortality were 1.05 (1.02 to 1.08), 1.07 (1.03 to 1.10), 1.14 (1.03 to 1.25), and 1.11 (1.05 to 1.17) for 10 μg/m³respectively. Consistent patterns for lung cancer and cardiopulmonary causes were observed.Conclusions:Urban air pollution assessed in the 1970s was associated with increased mortality over 25 years in France.

We observed the daily trend in mortality rates during the 2003 heat wave in 13 of France’s largest cities. Mortality data were collected from July 25 to September 15 each year from 1999 through 2003. The conjunction of a maximum temperature of 35°C and a minimum temperature of 20°C was exceptional in 7 cities. An excess mortality rate was observed in the 13 towns, with disparities from +4% (Lille) to +142% (Paris).