title: The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project.
abstract: BACKGROUND
  The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.
  
  
  METHODS
  Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated.
  
  
  RESULTS
  The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions.
  
  
  CONCLUSIONS
  Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.
authors.affiliation: Department of Epidemiology, Regional Health Authority, Rome, Italy. dippoliti@asplazio.it
authors.forename: Daniela
authors.initials: D
authors.lastname: D'Ippoliti
authors.forename: Paola
authors.initials: P
authors.lastname: Michelozzi
authors.forename: Claudia
authors.initials: C
authors.lastname: Marino
authors.forename: Francesca
authors.initials: F
authors.lastname: de'Donato
authors.forename: Bettina
authors.initials: B
authors.lastname: Menne
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
authors.forename: Ursula
authors.initials: U
authors.lastname: Kirchmayer
authors.forename: Antonis
authors.initials: A
authors.lastname: Analitis
authors.forename: Mercedes
authors.initials: M
authors.lastname: Medina-Ramón
authors.forename: Anna
authors.initials: A
authors.lastname: Paldy
authors.forename: Richard
authors.initials: R
authors.lastname: Atkinson
authors.forename: Sari
authors.initials: S
authors.lastname: Kovats
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schneider
authors.forename: Agnès
authors.initials: A
authors.lastname: Lefranc
authors.forename: Carmen
authors.initials: C
authors.lastname: Iñiguez
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Perucci
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004190:Disasters / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009026:Mortality; D012737:Sex Factors; D013997:Time Factors