Conti Susanna, Meli Paola, Minelli Giada, Solimini Renata, Toccaceli Virgilia, Vichi Monica, Beltrano Carmen, Perini Luigi
Bureau of Statistics, National Centre of Epidemiology, Surveillance and Promotion of Health, Italian National Institute of Health (Istituto Superiore di Sanità), Viale Regina Elena 299, 00161 Rome, Italy.
Environ Res. 2005 Jul;98(3):390-9. doi: 10.1016/j.envres.2004.10.009. Epub 2004 Dec 8.
It is widely recognized that extreme climatic conditions during summer months may constitute a major public health threat. Owing to what is called the "urban heat island effect," as well as to the consequences of heat waves on health, individuals living in cities have an elevated risk of death when temperature and humidity are high compared to those living in suburban and rural areas. Studies on heat wave-related mortality have further demonstrated that the greatest increases in mortality occur in the elderly. Following the unusually hot summer of 2003 and the dramatic news from neighboring countries such as France, the Italian Minister of Health requested the Istituto Superiore di Sanita-Bureau of Statistics to undertake an epidemiologic study of mortality in Italy during Summer 2003 to investigate whether there had been an excess of deaths, with a particular focus on the elderly population.
Communal offices, which maintain vital statistics, were asked for the individual records of death of residents registered daily during the period 1 June-31 August 2003 and during the same period of 2002 for each of the 21 capitals of the Italian regions. As it was necessary to obtain mortality data quickly from many municipalities and to make the analysis as soon as possible, the method adopted was comparison of mortality counts during the heat wave with figures observed during the same period of the previous year.
Compared with 2002, between 1 June and 31 August 2003, there was an overall increase in mortality of 3134 (from 20,564 to 23,698). The greatest increase was among the elderly; 2876 deaths (92%) occurred among people aged 75 years and older, a more than one-fifth increase (21.3%, from 13.517 to 16.393%). The highest increases were observed in the northwestern cities, which are generally characterized by cold weather, and in individuals 75 years and older: Turin (44.9%), Trento (35.2%), Milan (30.6%), and Genoa (22.2%). Of note are also the increases observed in two southern cities, L'Aquila (24.7%) and Potenza (25.4%), which are located, respectively, at 700 and 800 m above see level. For Bari and Campobasso, both in the South, with a typically hot summer climate, the increase during the last 15 days of August was 186.2 and 450%, respectively.
The relationship between mortality and discomfort due to climatic conditions as well as the short lag time give a clear public health message: preventive, social, and health care actions must be administered to the elderly and the frail to avoid excess deaths during heat waves.
人们普遍认识到，夏季的极端气候条件可能构成重大的公共卫生威胁。由于所谓的“城市热岛效应”以及热浪对健康的影响，与生活在郊区和农村地区的人相比，城市居民在气温和湿度较高时死亡风险升高。关于与热浪相关的死亡率的研究进一步表明，死亡率增幅最大的是老年人。在经历了2003年异常炎热的夏季以及来自法国等邻国的惊人消息之后，意大利卫生部长要求国家统计局进行一项关于2003年夏季意大利死亡率的流行病学研究，以调查是否存在死亡人数过多的情况，特别关注老年人群体。
向负责维护人口动态统计数据的市政办公室索要了2003年6月1日至8月31日期间以及2002年同期意大利21个大区首府每日登记的居民个人死亡记录。由于需要尽快从许多市政当局获取死亡率数据并尽快进行分析，所采用的方法是将热浪期间的死亡人数与上一年同期观察到的数据进行比较。
与2002年相比，2003年6月1日至8月31日期间，总死亡人数增加了3134人（从20,564人增至23,698人）。增幅最大的是老年人；75岁及以上人群中有2876人死亡（占92%），增加了五分之一以上（21.3%，从13,517人增至16,393人）。增幅最高的是西北部城市，这些城市通常气候寒冷，以及75岁及以上的人群：都灵（44.9%）、特伦托（35.2%）、米兰（30.6%）和热那亚（22.2%）。同样值得注意的是，位于海拔700米和800米的两个南部城市拉奎拉（24.7%）和波坦察（25.4%）的死亡人数也有所增加。对于南部典型夏季炎热气候的巴里和坎波巴索，8月最后15天的增幅分别为186.2%和450%。
死亡率与气候条件导致的不适之间的关系以及较短的滞后时间传递了一个明确的公共卫生信息：必须对老年人和体弱人群采取预防、社会和医疗保健行动，以避免热浪期间出现过多死亡。
