Heudorf U, Schade M
Amt für Gesundheit, Breite Gasse 28, 60313, Frankfurt am Main, Germany,
Z Gerontol Geriatr. 2014 Aug;47(6):475-82. doi: 10.1007/s00391-014-0673-2.
Following the heat wave of August 2003 that caused over 70,000 fatalities in Western Europe, heat-health action plans (HHAP) and heat warning systems were implemented in many European countries, including Germany. The effect of these preventive measures (informing the population as well as nursing and medical personnel) on excess mortality during heat waves in Frankfurt am Main, Germany, is studied, taking into account newly published data on a modifying effect of air pollution on heat mortality.
Mortality data comprising all deaths registered in the city of Frankfurt was obtained from the statistical state office; air temperature and air pollution data in Frankfurt Ost were obtained from the Hessian state office for environment and geology. SPSS Version 15 was used for statistical analysis (bivariate and partial correlations, nonparametric tests/Kruskal-Wallis, and Mann-Whitney test).
Temperature data as well as air pollution and daily mortality exhibited extreme values in summer 2003 compared to the summer periods 2004-2013. Never again were such levels of temperature and air pollution reached. In 2003, excess mortality was 78%, and as high as 113% among the population aged >80 years. During the heat wave of 2010, the total excess mortality was 23% (significant) and 38% in the population aged >80 years, while during heat waves in 2006 and 2013 no significant increase in total mortality was seen (total excess mortality 12% and 4%; not significant).
Lower excess mortality could be seen in Frankfurt am Main during heat waves following the implementation of HHAP and the heat warning system. This might be an effect of the measures implemented by the HHAP to reduce heat mortality. However, it cannot be ruled out that this might also be an effect of shorter heat wave periods and lower air pollution in the subsequent years. Therefore, further efforts are needed to improve the resilience of the population, especially the elderly population, to better cope with heat waves.
2003年8月的热浪致使西欧超过7万人死亡，之后包括德国在内的许多欧洲国家实施了热健康行动计划（HHAP）和高温预警系统。本研究考虑到新公布的关于空气污染对热死亡率有修正作用的数据，探讨了这些预防措施（向公众以及护理和医疗人员提供信息）对德国美因河畔法兰克福热浪期间超额死亡率的影响。
从州统计局获取美因河畔法兰克福市所有登记死亡的死亡率数据；从黑森州环境与地质局获取法兰克福东部的气温和空气污染数据。使用SPSS 15版进行统计分析（双变量和偏相关、非参数检验/克鲁斯卡尔-沃利斯检验和曼-惠特尼检验）。
与2004 - 2013年夏季相比，2003年夏季的温度数据以及空气污染和每日死亡率均出现极值。此后再也未达到过那样的温度和空气污染水平。2003年，超额死亡率为78%，80岁以上人群高达113%。2010年热浪期间，总超额死亡率为23%（显著），80岁以上人群为38%，而2006年和2013年热浪期间总死亡率未见显著增加（总超额死亡率分别为12%和4%；不显著）。
在实施HHAP和高温预警系统后，美因河畔法兰克福热浪期间超额死亡率有所降低。这可能是HHAP为降低热死亡率所采取措施的效果。然而，不能排除这也可能是后续年份热浪期较短和空气污染较低的结果。因此，需要进一步努力提高人群尤其是老年人群的适应能力，以更好地应对热浪。
