The August 2003 heat wave in France resulted in many thousands of excess deaths particularly of elderly people. Individual and environmental risk factors for death among the community-dwelling elderly were identified. We conducted a case-control survey and defined cases as people aged 65 years and older who lived at home and died from August 8 through August 13 from causes other than accident, suicide, or surgical complications. Controls were matched with cases for age, sex, and residential area. Interviewers used questionnaires to collect data. Satellite pictures provided profiles of the heat island characteristics around the homes. Lack of mobility was a major risk factor along with some pre-existing medical conditions. Housing characteristics associated with death were lack of thermal insulation and sleeping on the top floor, right under the roof. The temperature around the building was a major risk factor. Behaviour such as dressing lightly and use of cooling techniques and devices were protective factors. These findings suggest people with pre-existing medical conditions were likely to be vulnerable during heat waves and need information on how to adjust daily routines to heat waves. In the long term, building insulation and urban planning must be adapted to provide protection from possible heat waves.

Background: Heat waves have a drastic impact on urban populations, which could increase with climate change.Objectives: We evaluated new indicators of elderly people’s exposure to heat in Paris, from a public health prevention perspective, using satellite thermal images.Methods: We used a time series of 61 images from the satellites of the National Oceanic and Atmospheric Administration’s (NOAA) Advanced Very High Resolution Radiometer (AVHRR) taken from 1 to 13 August 2003 to produce thermal indicators of minimum, maximum, and mean surface temperatures and diurnal temperature amplitude, with different lags between the meteorological data and the health impact. Health data came from a case–control study involving 241 people ≥ 65 years of age who died in the city of Paris or the nearby suburban area of Val-de-Marne during the August 2003 heat wave, and 241 controls who were matched to cases on age, sex, and residential zone. For each person, we integrated the thermal indicators in a conditional logistic regression model, adjusted for age and other potential confounders. We computed odds ratios (ORs) comparing the 90th and 50th percentiles of the temperature differences between cases and controls for various indicators.Results: Mortality risk was significantly associated with exposure for two indicators: minimum temperatures averaged for 1–13 August [for a 0.41°C increase, OR = 2.17; 95% confidence interval (CI): 1.14, 4.16] and minimum temperature averaged on the day of death and the 6 preceding days (for a 0.51°C increase: OR = 2.24; 95% CI: 1.03, 4.87).Conclusions: Our results support the influence of night temperatures on the health impact of heat waves in urban areas. Urban heat exposure indicators based on satellite imagery have the potential to identify areas with higher risk of death, which could inform intervention decisions by key stakeholders.

Summer warming trends in Western Europe are increasing the incidence, intensity and duration of heat waves. They are especially deadly in large cities owing to population density, physical surface properties, anthropogenic heat and pollutants. In August 2003, for 9 consecutive days, the Paris metropolitan area experienced an extreme heat wave that caused 4867 estimated heat-related deaths. A set of 61 NOAA-AVHRR (advanced very high-resolution radiometer) images and one SPOT-high resolution visible (HRV) image were used to analyse the spatial variations of land surface temperature (LST) over the diurnal cycle during the heat wave. The LST patterns were markedly different between daytime and night-time. A heat island was centred downtown at night, whereas multiple temperature anomalies were scattered in the industrial suburbs during the day. The heat wave corresponded to elevated nocturnal LST compared to normal summers. The highest mortality ratios matched the spatial distribution of the highest night-time LSTs, but were not related to the highest daytime LSTs. LSTs were sampled from images at the addresses of 482 elderly people (half were deceased persons and half were control ones) to produce daily and cumulative minimal, maximal and mean thermal indicators, over various periods of time. These indicators were integrated into a conditional logistic regression model to test their use as heat exposure indicators, based on risk factors. Over the period 1-13 August, thermal indicators taking into account minimum nocturnal temperatures averaged over 7 days or over the whole period were significantly linked to mortality. These results show the extent of the spatial variability in urban climate variables and the impact of night-time temperatures on excess mortality. These results should be used to inform policy and contingency planning in relation to heat waves, and highlight the role that satellite remote sensing can play in documenting and preventing heat-related mortality.

Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.

Given the potentially life-threatening complications of PIs, cumulative radiograph doses received in the ICU seem low with regard to environmental exposure and international recommendations. Additional studies are needed to evaluate the possible lifetime consequences of exposure to ionizing radiation at this age.