P. Empereur-Bissonnet

Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave

BACKGROUNDnIn July 2006, a lasting and severe heat wave occurred in Western Europe. Since the 2003 heat wave, several preventive measures and an alert system aiming at reducing the risks related to high temperatures have been set up in France by the health authorities and institutions. In order to evaluate the effectiveness of those measures, the observed excess mortality during the 2006 heat wave was compared to the expected excess mortality.nnnMETHODSnA Poisson regression model relating the daily fluctuations in summer temperature and mortality in France from 1975 to 2003 was used to estimate the daily expected number of deaths over the period 2004-2006 as a function of the observed temperatures.nnnRESULTSnDuring the 2006 heat wave (from 11 to 28 July), about 2065 excess deaths occurred in France. Considering the observed temperatures and with the hypothesis that heat-related mortality had not changed since 2003, 6452 excess deaths were predicted for the period. The observed mortality during the 2006 heat wave was thus markedly less than the expected mortality (approximately 4400 less deaths).nnnCONCLUSIONSnThe excess mortality during the 2006 heat wave, which was markedly lower than that predicted by the model, may be interpreted as a decrease in the populations vulnerability to heat, together with, since 2003, increased awareness of the risk related to extreme temperatures, preventive measures and the set-up of the warning system.

Risk for non Hodgkin’s lymphoma in the vicinity of French municipal solid waste incinerators

BackgroundDioxin emissions from municipal solid waste incinerators are one of the major sources of dioxins and therefore are an exposure source of public concern. There is growing epidemiologic evidence of an increased risk for non-Hodgkins lymphoma (NHL) in the vicinity of some municipal solid waste incinerators with high dioxin emission levels. The purpose of this study was to examine this association on a larger population scale.MethodsThe study area consisted of four French administrative departments, comprising a total of 2270 block groups. NHL cases that had been diagnosed during the period 1990–1999, and were aged 15 years and over, were considered. Each case was assigned a block group by residential address geocoding. Atmospheric Dispersion Model System software was used to estimate immissions in the surroundings of 13 incinerators which operated in the study area. Then, cumulative ground-level dioxin concentrations were calculated for each block group. Poisson multiple regression models, incorporating penalized regression splines to control for covariates and dealing with Poisson overdispersion, were used. Five confounding factors were considered: population density, urbanisation, socio-economic level, airborne traffic pollution, and industrial pollution.ResultsA total of 3974 NHL incident cases was observed (2147 among males, and 1827 among females) during the 1990–1999 time period. A statistically significant relationship was found at the block group level between risk for NHL and dioxin exposure, with a relative risk (RR) of 1.120 (95% confidence interval [CI] 1.002 – 1.251) for persons living in highly exposed census blocks compared to those living in slightly exposed block groups. Population density appeared positively linked both to risk for NHL and dioxin exposure. Subgroup multivariate analyses per gender yielded a significant RR for females only (RR = 1.178, 95% CI 1.013 – 1.369).ConclusionThis study, in line with previous results obtained in the vicinity of the incinerator located in Besançon (France), adds further evidence to the link between NHL incidence and exposure to dioxins emitted by municipal solid waste incinerators. However, the findings of this study cannot be extrapolated to current incinerators, which emit lower amounts of pollutants.

Cold spells and health: prevention and warning.

OBJECTIVESnThe aim of this paper is to point out the kinds of measures that should be implemented to protect the population from the health effects of cold and when to put them into action, thanks to meteorological thresholds.nnnSTUDY DESIGNnThe authors used pertinence criteria to determine if an alert system would be relevant to trigger preventive measures.nnnMETHODSnThe pertinence criteria included ability to prevent health impact through specific measures, simplicity, reactivity, adaptability, and the possibility to find indicators able to predict a health impact of cold. This was investigated in two pilot cities, using time-series models to identify mortality-relevant thresholds, if any.nnnRESULTSnShort-term measures are mainly directed at homeless people while actions focussing on the general population are mostly limited to providing advice on how to protect oneself from exposure to cold. The main long-term measures are housing insulation and heating. Combined minimum and maximum temperatures are the best indicators to predict the health impact of cold temperatures on mortality. Associated optimal thresholds for action in Paris were -9xa0°C and -2xa0°C for minimum and maximum temperatures respectively while thresholds in Marseille were -3xa0°C and +4xa0°C. When both thresholds are reached in a given city, the risk of excess mortality is greater than 15%.nnnCONCLUSIONnSimple meteorological indicators could be used to improve the detection of dangerous cold episodes and promote communication. Nevertheless, long-term housing improvement and financial aids for home heating remain the best means to prevent the adverse effects of cold weather on community health.

Revue généraleÉtude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Première partie : les indicateurs de santé déclaréeStudy of self-reported health of people living near point sources of environmental pollution: A review. First part: Health indicators

BACKGROUNDnEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.nnnMETHODSnThe literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.nnnRESULTSnThe literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.nnnCONCLUSIONnThe choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used.

Étude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Première partie : les indicateurs de santé déclarée

BACKGROUNDnEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.nnnMETHODSnThe literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.nnnRESULTSnThe literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.nnnCONCLUSIONnThe choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used.