Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions.
BACKGROUND
In France, the August 2003 heat wave was responsible for considerable excess mortality among the elderly. We wonder whether the dependency level could be a marker of the risk for mortality during this heat wave.


METHODS
Retrospective cohort study of deaths that occurred between 1 and 20 August 2003, conducted in five departments in the Paris area (Ile-de-France) among the beneficiaries of the Allocation personnalisée d'autonomie (APA), a stipend specifically allocated to dependent subjects > or =60 years of age. Their dependency level was determined by the GIR group (defined by the French law) used to fix the APA amount. Subjects' GIR group classification and demographic variables were obtained from departmental administrative files.


RESULTS
Among the 31,603 APA beneficiaries alive on 31 July 2003, 16,779 were community dwellers and 14,824 lived in institutions. Between 1 and 20 August 2003, 858 subjects died: 300 community dwellers and 558 institutionalised (mortality rates of 2.7, 1.8 and 3.8 per cent, respectively). Independent risk factors for mortality were: age, sex and GIR group in community dwellers; age, GIR group and living in a region highly exposed to heatwave mortality for institutionalised elderly; independent factors for mortality were age, sex, GIR group, type of residence (institution/community), living in a region highly exposed to heatwave mortality and income for the overall population.


CONCLUSIONS
The dependency level was associated with mortality during the 2003 heatwave in France, especially for elderly community dwellers. Dependency might help identify high-risk subjects and guide targeted prevention measures against heatwave-associated mortality.
Belmin
Joël
J
Service de gériatrie, Hôptal Charles Foix and Université Paris 6, Ivry-sur-Seine, France.
Auffray
Jean-Christian
JC
Berbezier
Christine
C
Boirin
Pascal
P
Mercier
Sophie
S
de Reviers
Béatrice
B
Golmard
Jean-Louis
JL
D000203:Activities of Daily Living; D000367:Age Factors; D002423:Cause of Death; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D018882:Heat Stress Disorders / Q000401:mortality*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D010297:Paris / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data