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International Notes Heat-Related Mortality -- Latium Region, Italy, Summer 1983

During the 16-day period July 19-August 3, 1983, temperatures recorded in various parts of Italy remained consistently above the 1946-1970 average (1). Maximum temperatures recorded in the center of Rome were 34 C (93.2 F) or higher on 13 consecutive days and 36 C (96.8 F) or higher on 5 consecutive days (July 25-July 29) (2).

To assess the impact of the heat wave on the health status of the population, members of the Regional Epidemiologic Unit (Osservatorio Epidemiologico Regionale) for the Latium Region,* analyzed mortality during the heat wave and during a control period. Rome residents comprise about 60% of the approximately 5 million people living in the region; the rest are distributed among small towns and villages of 10,000-100,000 inhabitants. Region-wide mortality data are usually available only after considerable delay. To acquire more timely information, directors of all hospitals and clinics of the region were requested to report all patients who died each week during both July and August of 1982 and 1983 and to fill out a questionnaire for each patient who died from hyperpyrexia during the summer of 1983. Data from death certificates of Rome residents who died during these periods were also analyzed.

A death from heatstroke was defined as any death from July 19, to August 4, 1983, in which the patient's temperature before death measured at any site was 41.1 C (106 F) or 40.6 C (105 F) or higher if altered mental status and/or anhidrosis was also present. Patients with any of the following causes of fever were excluded: cerebral hemorrhage, neoplasia, x-ray-documented bronchopneumonia, bacteremia proven by blood culture, or laboratory-documented urinary-tract infection.

A total of 2,182 Rome residents died in Rome during July 1983 from all causes, but only 1,774 in July 1982, an increase of 408 (23%); in August 1983 and 1982, 1,534 and 1,468 residents died, respectively. Four hundred thirty-seven more deaths among persons aged 65 years and older occurred in July 1983 than in July 1982--a 35% increase. Only eight more persons aged 45-64 years died in 1983 than in 1982. Deaths decreased among infants and among persons under 45 years old. The percentage increase in deaths during July 1983 over 1982 was similar for both sexes among those aged 65-74 years and 85 years and older; it was higher for women (55.1%) than for men (25.8%) aged 75-84 years.

There were 369 more cardiovascular-related deaths (including deaths from cerebrovascular accidents) in July 1983 than in July 1982, a 58.7% increase. A smaller increase occurred in deaths from neoplastic disease--68, up 13.2% from the previous year. All other major causes of death showed slight decreases. The increase in deaths occurred during the 2 weeks of July 22-August 4, when the highest temperatures were recorded (Figure 1).

Data were available from 55 of the region's 91 hospitals (representing 79% of 28,822 hospital beds) and 90 of its 156 clinics. A total of 1,692 deaths were recorded in July 1983, 384 more than in July 1982, a 29.3% increase. The increase was more pronounced in hospitals and clinics situated outside Rome (48.5%) than in Rome (25.3%). Eighty-four cases met the temperature criteria for heatstroke death, but 19 were excluded because another cause of fever was present; among the remaining 65 heatstroke deaths, 23 were of males, and 42, of females. Sixty-two heatstroke deaths occurred during July 22-August 4, representing 18% of the 338 excess hospital deaths recorded during the same period. The temporal distribution of deaths and the maximum daily temperatures recorded for the center of Rome are shown in Figure 2. Of the 60 cases for which age was specified, 45 persons (75%) were aged 65 years and older, and 33 (55%), aged 75 years and older. Of previously reported risk factors for heatstroke (3), information was available only on the use of major tranquilizers and anticholinergic drugs. These medications were used by eight (53.3%) of the 15 patients under age 65 and by 10 (22.2%) of the 45 patients aged 65 years or older. Death followed the onset of symptoms by less than 48 hours in three-fourths of the cases. Reported by F Albertoni, M Arca, P Borgia, C Perucci, C Tasco, Osservatorio Epidemiologico Regione Lazio, G Ippolito, Ospedale L Spallanzani-Centro Epidemiologico; Investigations Section, Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Sharp increases in total mortality during periods of sustained high temperatures (heat waves) have been reported from the United States (4-8), Australia (9), and Europe (10,11). Increased mortality associated with a heat wave was recently reported in New York City (12). As in previous reports, the increase in deaths noted here occurred primarily among elderly persons. Diagnosed heatstroke deaths accounted for only a small portion of that increase. This finding is consistent with results usually found in previous studies--deaths recognized by physicians as being heat-related account for fewer than 50% of excess deaths associated with a heat wave. The marked increase in deaths attributable to cardiovascular and cerebrovascular events accounted for much of the increase in total mortality during the 1983 heat wave in the Latium Region. Deaths attributed to these causes also increase during heat waves in the United States (13,14). In contrast, the geographic pattern of heat-wave casualties in this report differs from that of the United States, where rates of heat-related adverse health consequences are much higher in urban than in suburban or rural areas (4).

References

  1. Aeronautica Militare Italiana. Bollettino Meteorologico.

  2. Ministerio dell'agricoltura. Ufficio Meteorologico.

  3. Kilbourne EM, Choi K, Jones TS, Thacker SB. Risk factors for heatstroke. A case-control study. JAMA 1982;247:3332-6.

  4. Jones TS, Liang AP, Kilbourne EM, et al. Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, Missouri. JAMA 1982;247:3327-31.

  5. Gover M. Mortality during periods of excessive temperature. Public Health Rep 1938;53:1122-43.

  6. Kutschenreuter PH. A study of the effect of weather on mortality. Trans NY Acad Sci 1959;22:126-38.

  7. Oechsli RW, Buechley WB. Excess mortality associated with three Los Angeles September hot spells. Environ Res 1970;3:277-84.

  8. Ellis FP. Mortality from heat illness and heat-aggravated illness in the United States. Environ Res 1972;5:1-58.

  9. Macpherson RK, Ofner F, Welch JA. Effect of the prevailing air temperature on mortality. Br J Prev Soc Med 1967;21:17-21.

  10. Ellis FP, Prince HP, Lovatt G, Whittington RM. Mortality and morbidity in Birmingham during the 1976 heatwave. Quart J Med 1980;49:1-8.

  11. Liedermann A. Hitze und sterberisiko in einer grossstadt. Analyse der sterbefalle, die sich wahrend der hitze welle in sommer 1976 in stuttkgart ereinghneten (elevated temperatures and risk of death in large cities). Bundesgesundheitsblatt 1979;22:289-92.

  12. CDC. Heat-associated mortality--New York City. MMWR 1984;33:430-2.

  13. Schuman SH. Patterns of urban heat-wave deaths and implications for prevention: Data from New York and St. Louis during July, 1966. Environ Res 1972;5:59-75.

  14. Schuman SH, Anderson CP, Oliver JT. Epidemiology of successive heat waves in Michigan in 1962 and 1963. JAMA 1964;189:733-8. *One of 20 regions into which Italy is geographically and administratively divided.



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