Small-area spatiotemporal analysis of heatwave impacts on elderly mortality in Paris: A cluster analysis approach.
BACKGROUND
Heat-waves have a substantial public health burden. Understanding spatial heterogeneity at a fine spatial scale in relation to heat and related mortality is central to target interventions towards vulnerable communities.


OBJECTIVE
To determine the spatial variability of heat-wave-related mortality risk among elderly in Paris, France at the census block level. We also aimed to assess area-level social and environmental determinants of high mortality risk within Paris.


METHODS
We used daily mortality data from 2004 to 2009 among people aged >65 at the French census block level within Paris. We used two heat wave days' definitions that were compared to non-heat wave days. A Bernoulli cluster analysis method was applied to identify high risk clusters of mortality during heat waves. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the mortality risk.


RESULTS
The spatial approach revealed a spatial aggregation of death cases during heat wave days. We found that small scale chronic PM10exposure was associated with a 0.02 (95% CI: 0.001; 0.045) increase of the risk of dying during a heat wave episode. We also found a positive association with the percentage of foreigners and the percentage of labor force, while the proportion of elderly people living in the neighborhood was negatively associated. We also found that green space density had a protective effect and inversely that the density of constructed feature increased the risk of dying during a heat wave episode.


CONCLUSIONS
We showed that a spatial variation in terms of heat-related vulnerability exists within Paris and that it can be explained by some contextual factors. This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves.
Department of Family Medicine and Public Health, Scripps Institution of Oceanography, University of California, San Diego, CA, USA. Electronic address: tbenmarhnia@ucsd.edu.
Tarik
T
Benmarhnia
EHESP School of Public Health-Rennes, Sorbonne-Paris Cité, France.
Wahida
W
Kihal-Talantikite
Swiss Tropical and Public Health Institute, Basel 4002, Switzerland; University of Basel, Basel 4003, Switzerland.
Martina S
MS
Ragettli
EHESP School of Public Health-Rennes, Sorbonne-Paris Cité, France.
Séverine
S
Deguen
D000368:Aged; D016000:Cluster Analysis; D006358:Hot Temperature; D006801:Humans; D009026:Mortality; D010297:Paris; D018570:Risk Assessment; D062211:Spatio-Temporal Analysis
Air pollution; Green space; Heat waves; Heat-related mortality; Social inequalities in health; Spatiotemporal analysis; Urban Heat Island; Vulnerability