International Notes Heat-Related Mortality -- Latium
Region, Italy, Summer 1983
During the 16-day period July 19-August 3, 1983, temperatures
recorded in various parts of Italy remained consistently above the
1946-1970 average (1). Maximum temperatures recorded in the center
of
Rome were 34 C (93.2 F) or higher on 13 consecutive days and 36 C
(96.8 F) or higher on 5 consecutive days (July 25-July 29) (2).
To assess the impact of the heat wave on the health status of
the
population, members of the Regional Epidemiologic Unit
(Osservatorio
Epidemiologico Regionale) for the Latium Region,* analyzed
mortality
during the heat wave and during a control period. Rome residents
comprise about 60% of the approximately 5 million people living in
the
region; the rest are distributed among small towns and villages of
10,000-100,000 inhabitants. Region-wide mortality data are usually
available only after considerable delay. To acquire more timely
information, directors of all hospitals and clinics of the region
were
requested to report all patients who died each week during both
July
and August of 1982 and 1983 and to fill out a questionnaire for
each
patient who died from hyperpyrexia during the summer of 1983. Data
from death certificates of Rome residents who died during these
periods were also analyzed.
A death from heatstroke was defined as any death from July 19,
to
August 4, 1983, in which the patient's temperature before death
measured at any site was 41.1 C (106 F) or 40.6 C (105 F) or higher
if
altered mental status and/or anhidrosis was also present. Patients
with any of the following causes of fever were excluded: cerebral
hemorrhage, neoplasia, x-ray-documented bronchopneumonia,
bacteremia
proven by blood culture, or laboratory-documented urinary-tract
infection.
A total of 2,182 Rome residents died in Rome during July 1983
from
all causes, but only 1,774 in July 1982, an increase of 408 (23%);
in
August 1983 and 1982, 1,534 and 1,468 residents died, respectively.
Four hundred thirty-seven more deaths among persons aged 65 years
and
older occurred in July 1983 than in July 1982--a 35% increase.
Only
eight more persons aged 45-64 years died in 1983 than in 1982.
Deaths
decreased among infants and among persons under 45 years old. The
percentage increase in deaths during July 1983 over 1982 was
similar
for both sexes among those aged 65-74 years and 85 years and older;
it
was higher for women (55.1%) than for men (25.8%) aged 75-84 years.
There were 369 more cardiovascular-related deaths (including
deaths from cerebrovascular accidents) in July 1983 than in July
1982,
a 58.7% increase. A smaller increase occurred in deaths from
neoplastic disease--68, up 13.2% from the previous year. All other
major causes of death showed slight decreases. The increase in
deaths
occurred during the 2 weeks of July 22-August 4, when the highest
temperatures were recorded (Figure 1).
Data were available from 55 of the region's 91 hospitals
(representing 79% of 28,822 hospital beds) and 90 of its 156
clinics.
A total of 1,692 deaths were recorded in July 1983, 384 more than
in
July 1982, a 29.3% increase. The increase was more pronounced in
hospitals and clinics situated outside Rome (48.5%) than in Rome
(25.3%). Eighty-four cases met the temperature criteria for
heatstroke death, but 19 were excluded because another cause of
fever
was present; among the remaining 65 heatstroke deaths, 23 were of
males, and 42, of females. Sixty-two heatstroke deaths occurred
during July 22-August 4, representing 18% of the 338 excess
hospital
deaths recorded during the same period. The temporal distribution
of
deaths and the maximum daily temperatures recorded for the center
of
Rome are shown in Figure 2. Of the 60 cases for which age was
specified, 45 persons (75%) were aged 65 years and older, and 33
(55%), aged 75 years and older. Of previously reported risk
factors
for heatstroke (3), information was available only on the use of
major
tranquilizers and anticholinergic drugs. These medications were
used
by eight (53.3%) of the 15 patients under age 65 and by 10 (22.2%)
of
the 45 patients aged 65 years or older. Death followed the onset
of
symptoms by less than 48 hours in three-fourths of the cases.
Reported by F Albertoni, M Arca, P Borgia, C Perucci, C Tasco,
Osservatorio Epidemiologico Regione Lazio, G Ippolito, Ospedale L
Spallanzani-Centro Epidemiologico; Investigations Section, Special
Studies Br, Chronic Diseases Div, Center for Environmental Health,
CDC.
Editorial Note
Editorial Note: Sharp increases in total mortality during periods
of
sustained high temperatures (heat waves) have been reported from
the
United States (4-8), Australia (9), and Europe (10,11). Increased
mortality associated with a heat wave was recently reported in New
York City (12). As in previous reports, the increase in deaths
noted
here occurred primarily among elderly persons. Diagnosed
heatstroke
deaths accounted for only a small portion of that increase. This
finding is consistent with results usually found in previous
studies--deaths recognized by physicians as being heat-related
account
for fewer than 50% of excess deaths associated with a heat wave.
The
marked increase in deaths attributable to cardiovascular and
cerebrovascular events accounted for much of the increase in total
mortality during the 1983 heat wave in the Latium Region. Deaths
attributed to these causes also increase during heat waves in the
United States (13,14). In contrast, the geographic pattern of
heat-wave casualties in this report differs from that of the United
States, where rates of heat-related adverse health consequences are
much higher in urban than in suburban or rural areas (4).
References
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Kilbourne EM, Choi K, Jones TS, Thacker SB. Risk factors for
heatstroke. A case-control study. JAMA 1982;247:3332-6.
Jones TS, Liang AP, Kilbourne EM, et al. Morbidity and
mortality
associated with the July 1980 heat wave in St. Louis and Kansas
City, Missouri. JAMA 1982;247:3327-31.
Gover M. Mortality during periods of excessive temperature.
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Kutschenreuter PH. A study of the effect of weather on
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Ellis FP. Mortality from heat illness and heat-aggravated
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sommer 1976 in stuttkgart ereinghneten (elevated temperatures
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CDC. Heat-associated mortality--New York City. MMWR
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Schuman SH. Patterns of urban heat-wave deaths and
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for prevention: Data from New York and St. Louis during July,
1966. Environ Res 1972;5:59-75.
Schuman SH, Anderson CP, Oliver JT. Epidemiology of successive
heat waves in Michigan in 1962 and 1963. JAMA 1964;189:733-8.
*One of 20 regions into which Italy is geographically and
administratively divided.
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