title: Heat-related mortality in the Florentine area (Italy) before and after the exceptional 2003 heat wave in Europe: an improved public health response?
abstract: High ambient temperatures have been associated with increased mortality across the world. Several studies suggest that timely preventive measures may reduce heat-related excess mortality. The main aim of this study was to detect the temporal modification of heat-related mortality, in older adults (aged 65-74) and in elderly ≥75 years old, in the Florentine area by comparing previous (1999-2002) and subsequent (2004-2007) periods to the summer of 2003, when a regional Heat-Health Warning System (HHWS) was set up. Mortality data from 1999 to 2007 (May-September) were provided by the Mortality Registry of the Tuscany Region (n = 21,092). Weather data were used to assess daily apparent temperatures (AT). Case-crossover time-stratified designs and constrained segmented distributed lag models were applied. No significant heat-related mortality odds ratio (OR) variations were observed among the sub-periods. Nevertheless, a general OR decrease dating from 1999-2002 (OR 1.23; lack of HHWS) to 2004-2005 (OR 1.21; experimental HHWS running only for Florence) and to 2006-2007 (OR 1.12; official HHWS extended to the whole Florentine area) was observed when the maximum AT was considered. This modification was only evident in subjects ≥75 years old. The heat effect was higher and sustained for more days (until lag 9) during the period 1999-2002 than 2004-2007. The decrease of the excessive heat effect on mortality between periods with the absence and existence of a HHWS is also probably due to the mitigation of preventive measures and the implementation of a HHWS with specific interventions for safeguarding the health of the "frail elderly".
authors.affiliation: Interdepartmental Centre of Bioclimatology, University of Florence, Firenze, Italy. marco.morabito@unifi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Morabito
authors.forename: Francesco
authors.initials: F
authors.lastname: Profili
authors.forename: Alfonso
authors.initials: A
authors.lastname: Crisci
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Simone
authors.initials: S
authors.lastname: Orlandini
mesh_terms: D000368:Aged; D018882:Heat Stress Disorders / Q000401:mortality* / Q000517:prevention & control*; D006358:Hot Temperature; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016017:Odds Ratio; D011322:Primary Prevention; D014887:Weather