Rey Grégoire, Fouillet Anne, Bessemoulin Pierre, Frayssinet Philippe, Dufour Anne, Jougla Eric, Hémon Denis
U754, INSERM, Villejuif, France.
Eur J Epidemiol. 2009;24(9):495-502. doi: 10.1007/s10654-009-9374-3. Epub 2009 Jul 30.
Heat waves may become a serious threat to the health and safety of people who currently live in temperate climates. It was therefore of interest to investigate whether more deprived populations are more vulnerable to heat waves. In order to address the question on a fine geographical scale, the spatial heterogeneity of the excess mortality in France associated with the European heat wave of August 2003 was analysed. A deprivation index and a heat exposure index were used jointly to describe the heterogeneity on the Canton scale (3,706 spatial units). During the heat wave period, the heat exposure index explained 68% of the extra-Poisson spatial variability of the heat wave mortality ratios. The heat exposure index was greater in the most urbanized areas. For the three upper quintiles of heat exposure in the densely populated Paris area, excess mortality rates were twofold higher in the most deprived Cantons (about 20 excess deaths/100,000 people/day) than in the least deprived Cantons (about 10 excess deaths/100,000 people/day). No such interaction was observed for the rest of France, which was less exposed to heat and less heterogeneous in terms of deprivation. Although a marked increase in mortality was associated with heat wave exposure for all degrees of deprivation, deprivation appears to be a vulnerability factor with respect to heat-wave-associated mortality.
热浪可能会对目前生活在温带气候地区的人们的健康和安全构成严重威胁。因此，研究贫困程度较高的人群是否更容易受到热浪影响具有重要意义。为了在精细的地理尺度上解决这个问题，我们分析了2003年8月欧洲热浪期间法国与热浪相关的超额死亡率的空间异质性。我们联合使用了一个贫困指数和一个热暴露指数来描述行政区尺度（3706个空间单元）上的异质性。在热浪期间，热暴露指数解释了热浪死亡率比的超泊松空间变异性的68%。热暴露指数在城市化程度最高的地区更高。在人口密集的巴黎地区，对于热暴露程度最高的三个五分位数，最贫困行政区的超额死亡率（约20例/10万人/天）是最不贫困行政区（约10例/10万人/天）的两倍。在法国其他地区未观察到这种相互作用，这些地区受热程度较低，贫困程度的异质性也较小。尽管所有贫困程度的人群因热浪暴露导致的死亡率都显著增加，但贫困似乎是与热浪相关死亡率的一个脆弱因素。
