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Journal of Public Health Advance Access originally published online on October 18, 2005
Journal of Public Health 2005 27(4):359-365; doi:10.1093/pubmed/fdi059
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© The Author 2005, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Were less disabled patients the most affected by 2003 heat wave in nursing homes in Paris, France?



Josiane Holstein
Josiane Holstein, MD, Department of Medical Information, Assistance Publique-Hôpitaux de Paris, 3 Avenue Victoria, 75004 Paris Cedex 04, France


Florence Canouï-Poitrine
Florence Canouï-Poitrine, MD, Epidemiology and Public Health Department, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex 08, France


Anke Neumann

Eric Lepage
Anke Neumann, PhD, Eric Lepage, MD PhD, Department of Medical Information, Assistance Publique-Hôpitaux de Paris, 3 Avenue Victoria, 75004 Paris Cedex 04, France


Alfred Spira
Alfred Spira, MD PhD, Epidemiology and Public Health Department, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex 08, France

Address correspondence to Josiane Holstein. Email: josiane.holstein{at}sap.ap-hop-paris.fr

Objective To analyse the change of mortality rates (MRs) and their contributing medical factors among nursing home patients during the 2003 heat wave in France.

Methods A retrospective observational study was conduced in all nursing homes of the Assistance-Publique-Hôpitaux de Paris (AP-HP), the French largest public hospital group. All AP-HP nursing home patients (4403) who were institutionalized in May, 2003, were concerned. The MRs of patients between three periods (before, during and after the August 2003 heat wave period) were compared according to their demographic characteristics, level of dependence and medical condition.

Results The MR increased from 2.2 per cent persons month (ppm) (1.9–2.4) before heat wave up to 9.2 ppm (8.0–10.4) during heat wave and back to 2.4 ppm (2.2–2.7) after heat wave. MRs before heat wave were higher among highly dependent patients compared to those less dependent [mortality rate ratio (MRR) = 2.66 (1.69–4.21)]. This difference disappeared during the heat wave [MRR = 1.28 (0.91–1.81)] and appeared again after heat wave [MRR = 2.21 (1.52–3.23)]. The same pattern was observed for several medical conditions, such as severe malnutrition or swallowing disorders.

Conclusion These results suggest that medical care during heat wave has been directed towards more fragile patients, helping to limit deaths in this group. Less frail patients made the largest contribution to excess mortality during the heat wave. During extreme weather conditions, specific attention should be paid not only to frail persons, but to all the elderly community.

Keywords: heat wave, mortality, nursing home


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