Mortality in Portugal associated with the heat wave of August 2003: Early estimation of effect, using a rapid method

Abstract

During the first two weeks of August 2003, Portugal was affected by a severe heat wave. Following the identification in Portugal of the influence of heat waves on mortality in 1981 and 1991 (estimated excess of about 1900 and 1000 deaths respectively), the Observatório Nacional de Saúde (ONSA) - Instituto Nacional de Saúde Dr. Ricardo Jorge, together with the Vigilância Previsão e Informação - Instituto de Meteorologia, created a surveillance system called ÍCARO, which has been in operation since 1999. ÍCARO identifies heat waves with potential influence on mortality [1]. Before the end of the 2003 heat wave, ONSA had produced a preliminary estimate of its effect on mortality. The results based on daily number of deaths from 1 June to 12 August 2003 were presented within 4 working days. Data was gathered from 31 National Civil registrars, covering the district capitals of all 18 districts of mainland Portugal, and representing approximately 40% of the mainland's mortality. The number of deaths registered in the period 30 July to 12 August was compared with the ones registered during 3 comparison periods: (in July): 1-14 July, 1-28 July, and 15-28 July). 15-28 July, the period best resembling the heat wave in time and characteristics, produced an estimation of 37.7% higher mortality rate then the value expected under normal temperature conditions. From this value, an estimate of 1316 death excess was obtained for mainland Portugal. The main purpose of this article is to present the method used to identify and assess the occurrence of an effect (excess mortality) during the heat wave of summer 2003.

Excess mortality related to the August 2003 heat wave in France

“…On a larger scale, from June to August 2003, the whole of Western Europe was struck by a series of heat waves. Excess mortality was observed in Portugal (+1,316 deaths) (Nogueira et al 2005), Spain (+6,595-8,648 deaths) (Simon et al 2005), Italy (in 21 cities: +3,134 deaths) (Conti et al 2005), England and Wales (+2,139 deaths) (Johnson et al 2005), the Netherlands (+1,400-2,200 deaths) (Garssen et al 2005) and Switzerland (+975 deaths) (Grize et al 2005). Therefore, the overall excess death count of the 2003 heat wave is higher if all Western European countries are considered from June to August.…”

“…Those authors described the characteristics of the mortality during or after the heat wave (Applegate et al 1981;Buechley et al 1972;Dessai 2002;Ellis and Nelson 1978;Ellis et al 1980;Henschel et al 1969;Jones et al 1982;Katsouyanni et al 1993;Naughton et al 2002;Qiu et al 2002;Rooney et al 1998;Sartor et al 1995;Schuman 1972;Whitman et al 1997). Studies of the 2003 heat waves in Western Europe have been conducted for Portugal (Nogueira et al 2005), Spain (Simon et al 2005), Italy (Conti et al 2005), England and Wales (Johnson et al 2005), the Netherlands (Garssen et al 2005) and Switzerland (Grize et al 2005). The probable increase in the frequency of such events in the twentyfirst century has been stressed, as have the time-and place-dependence of the main characteristics of that mortality.…”

Decreased impacts of the 2003 heat waves on mortality in the Czech Republic: an improved response?

“…The June-August period in 2003 was the warmest summer in Europe since at least 1500 (Luterbacher et al 2004), very likely due in part to anthropogenic climate change. Large excess mortality during the 2003 heat waves was reported in western European countries, particularly in France (Vandentorren et al 2004;Poumadere et al 2005;Filleul et al 2006;Le Tertre et al 2006), Italy (MMWR 2004;Michelozzi et al 2005) and Spain (Martinez-Navarro et al 2004;Simón et al 2005), but also in Portugal (Nogueira et al 2005), the UK (Johnson et al 2005), the Netherlands (Garssen et al 2005), Switzerland (Grize et al 2005) and Germany (Heudorf and Meyer 2005). With an estimated death toll exceeding 50,000 over the June-August period (Larsen 2006), the 2003 heat waves were among the 10 deadliest natural disasters in Europe for the last 100 years, and the worst one over the last 50 years (De Bono et al 2004).…”

Urban Forests and Their Ecosystem Services in Relation to Human Health

“…Extreme heat waves in cities can cause considerable health problems for citizens, for example the sharply increased mortality during episodes of high temperature across Europe in 2003 (Michelozzi et al 2005;Nogueira et al 2005;Poumadere et al 2005). Whether UHI is a factor in global warming is unknown.…”