José Marinho Falcão

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

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 mainlands 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.

Tobacco consumption by the portuguese population. Data from the 2005–2006 National Health Survey

This study aims to contribute to the epidemiological portrayal of tobacco consumption in Portugal 2005- 2006, using data from the National Health Survey. In this analysis the Portuguese population is characterised according to smoking patterns, exposure to smoke and attitudes to smoking in general. Data is presented by gender, age groups, regions of residence and other social characteristics. Frequencies results are estimated values for the Portuguese population in 2005. Logistic binary regression models are used to study regular smoking-related characteristics. Results show that 20.9% of the Portuguese population (including Madeira and the Azores) aged 15 or more were smokers (male: 30.9%; female: 11.8%), and that 18.7% smoked regularly. More than one half of men were smokers or ex-smokers (56.9%) whereas the great majority of women had never smoked (81.3%). After removing the effect of the different age structures among regions, the highest rate of males who smoked regularly was observed in the Azores region (31.0%), followed by the Alentejo region (29.9%). The highest rate of women who smoked regularly occurred in the Lisbon and Tagus Valley region (15.4%), followed by the Algarve region (12.8%). Daily average cigarette consumption was higher among male (20 cigarettes) than female smokers (13 cigarettes). The Azores population presented the highest daily average consumption (male: 23 cigarettes; female: 16 cigarettes).

Air conditioning and intrahospital mortality during the 2003 heatwave in Portugal: evidence of a protective effect

Objectives The objective of the study was to analyse the association between the presence of air conditioning in hospital wards and the intrahospital mortality during the 2003 heatwave, in mainland Portugal. Methods Historical cohort study design including all patients aged 45 or more who were hospitalised in the 7 days before the heatwave. The outcome was survival during the 18 days the heatwave lasted and during the 2 days after the end of the heatwave. A comparison group was also selected in four analogous periods without any heatwave event during January to May 2003. Data were obtained from the 2003 hospital discharges database. Air conditioning presence in hospital wards was determined using a survey sent to hospital administrations. A Cox-regression model was used to estimate the confounder-adjusted HR of death, during the heatwave and the comparison period, in patients in wards with air conditioning (AC+) versus patients in wards without air conditioning (AC−). Results 41 hospitals of mainland Portugal (49% of all hospitals in mainland Portugal) participated, and 2093 patients were enrolled. The overall confounder-adjusted HR of death in AC+ patients versus AC− patients was 0.60 (95% CI 0.37 to 0.97) for the heatwave period and 1.05 (95% CI 0.84 to 1.32) for the comparison group. Conclusions The study found strong evidence that, during the August 2003 heatwave, the presence of air conditioning in hospital wards was associated with an increased survival of patients admitted before the beginning of the climate event. The reduction of the risk of dying is estimated to be 40% (95% CI 3% to 63%).

Vacinação anti-gripal: cobertura da população portuguesa entre 1998/1999 a 2002/2003

RESUMO Entre 1999 e 2003 o Observatorio Nacional de Saude realizou quatro inqueritos telefonicos (1998/ /99, 1999/00, 2001/02 e 2002/03) ao painel de familias ECOS - E m C asa O bservamos S aude, com o objectivo de estudar a cobertura com vacina antigripal da populacao portuguesa do Continente. Dos resultados obtidos destacam-se: A percentagem de individuos que declararam estar vacinados contra a gripe aumentou de forma consistente entre 1998/99 (14,2%) e 2001/02 (17,0%), apresentando uma descida, sem significado estatistico, na epoca de 2002/03 (15,0%). Foi no grupo etario dos individuos com 65 e mais anos que se verificou sempre a percentagem mais elevada de vacinados (36,9%, 2002/03), por outro lado, a percentagem mais baixa de vacinados foi verificada no grupo etario 15-44 anos (7,0%, 2002/ /03). Os individuos que declararam sofrer de doencas cronicas (asma/bronquite asmatica, doencas reumaticas, hipertensao arterial e diabetes), mostraram sempre percentagens de vacinados superiores a do total da populacao. Os valores mais elevados foram registados nos individuos com diabetes (34,5% 2002/03) e asma/bronquite asmatica (34,3% 2002/03). Nestas circunstâncias, afigura-se importante que seja promovida uma maior cobertura com a vacina anti-gripal dos individuos com 65 anos e mais, ja que essa cobertura nao e suficientemente elevada, nomeadamente se comparada com a de outros paises europeus. Embora sem ter disponiveis valores europeus de comparacao, afigura-se igualmente necessario aumentar a cobertura dos outros quatro grupos de risco incluidos neste estudo, bem como, possivelmente, daqueles que nele nao foram abordados. REV PORT PNEUMOL 2004; X (2): 115-123

Erratum to "Vacinação anti-gripal: cobertura da população portuguesa entre 1998/1999 a 2002/2003"

RESUMO Entre 1999 e 2003 o Observatorio Nacional de Saude realizou quatro inqueritos telefonicos (1998/ /99, 1999/00, 2001/02 e 2002/03) ao painel de familias ECOS - Em Casa Observamos Saude, com o objectivo de estudar a cobertura com vacina antigripal da populacao portuguesa do Continente. Dos resultados obtidos destacam-se: A percentagem de individuos que declararam estar vacinados contra a gripe aumentou de forma consistente entre 1998/99 (14,2%) e 2001/02 (17,0%), apresentando uma descida, sem significado estatistico, na epoca de 2002/03 (15,0%). Foi no grupo etario dos individuos com 65 e mais anos que se verificou sempre a percentagem mais elevada de vacinados (36,9%, 2002/03), por outro lado, a percentagem mais baixa de vacinados foi verificada no grupo etario 15-44 anos (7,0%, 2002/ /03). Os individuos que declararam sofrer de doencas cronicas (asma/bronquite asmatica, doencas reumaticas, hipertensao arterial e diabetes), mostraram sempre percentagens de vacinados superiores a do total da populacao. Os valores mais elevados foram registados nos individuos com diabetes (34,5% 2002/03) e asma/bronquite asmatica (34,3% 2002/03). Nestas circunstâncias, afigurase importante que seja promovida uma maior cobertura com a vacina anti-gripal dos individuos com 65 anos e mais, ja que essa cobertura nao e suficientemente elevada, nomeadamente se comparada com a de outros paises europeus. Embora sem ter disponiveis valores europeus de comparacao, afigura-se igualmente necessario aumentar a cobertura dos outros quatro grupos de risco incluidos neste estudo, bem como, possivelmente, daqueles que nele nao foram abordados. REV PORT PNEUMOL 2004; X (2): 115-123