Correspondence

Excess Rate of In-Hospital Death in Lyons, France, during the August 2003 Heat Wave

N Engl J Med 2003; 349:2077-2078November 20, 2003

Article

To the Editor:

We report descriptive data on mortality at the Edouard Herriot Hospital in Lyons, France, during the heat wave that lasted in France from August 1 to August 19, 2003. Figure 1Figure 1Absolute Daily Number of In-Hospital Deaths at Edouard Herriot Hospital and Daily Maximal Temperatures during the Summers of 2002 and 2003 in Lyons, France. depicts the absolute daily number of in-hospital deaths during the summers of 2002 and 2003 and the corresponding maximal temperatures. During the heat wave, the average temperature was 35.7°C; it was 25.1°C during the same period in 2002.

The Institut de Veille Sanitaire conducted a national survey between August 8 and August 19, 2003, to count the number of heat-related deaths, defined as exposure to hot weather, a body temperature of 40.6°C or higher, and an absence of other causes of hyperthermia. A total of 73 patients died at our hospital during the national survey, as compared with 23 during the same period in 2002; 30 of these 73 patients (41 percent) died from heat-related conditions according to the definition. The median age of these 30 patients was 85 years (range, 54 to 99), and more than 80 percent were older than 75; the ratio of men to women was 0.76. The median body temperature was 41.5°C (maximum, 43.3°C). Fourteen of the patients lived at home (including 5 who lived alone), and 11 lived in a long-term care facility; information on the housing situation for the other 5 patients was not available. The median length of stay between admission and death was one day (range, one to five) among the 21 persons (70 percent) who died from heat-related conditions after admission through the emergency department.

Excess rates of heat-related deaths have been reported elsewhere.1-4 We report a quantifiable increase in mortality with the heat wave in France in August 2003. These data need to be reanalyzed on an annual basis and compared with data from previous years. A heat wave may accelerate death for some patients without having an effect on the annual mortality rate.

Most of the patients who died were older than 80 years. Factors that may have contributed to the high risk associated with older age include social isolation, limited access to care, poor living conditions, and lack of availability of information related to heat-associated risks and their prevention.1 This crisis raised questions about public health alerts and surveillance.

Heat-related mortality may become an increasing concern if global temperatures rise as expected.4,5 Reducing such mortality will depend on social, economic, environmental, cultural, and health-related factors.

Philippe Vanhems, M.D., Ph.D.
Hôpital Edouard Herriot, 69437 Lyons, CEDEX 03, France
philipva@lyon-sud.univ-lyon1.fr

Laetitia Gambotti, M.D.
Laboratoire d'Epidémiologie et de Santé Publique,, INSERM Unité 271, 69373 Lyons, CEDEX 08, France

Jacques Fabry, M.D.
Hôpital Edouard Herriot, 69437 Lyons, CEDEX 03, France

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