Excess mortality related to the August 2003 heat wave in France.

Objectives: From August 1st to 20th, 2003, the mean maximum temperature in France exceeded the seasonal norm by 11-12 degrees C on nine consecutive days. A major increase in mortality was then observed, which main epidemiological features are described herein. Methods: The number of deaths observed from August to November 2003 in France was compared to those expected on the basis of the mortality rates observed from 2000 to 2002 and the 2003 population estimates. Results: From August 1st to 20th, 2003, 15,000 excess deaths were observed. From 35 years age, the excess mortality was marked and increased with age. It was 15% higher in women than in men of comparable age as of age 45 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality. The geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days. No harvesting effect was observed. Conclusions: Heat waves must be considered as a threat to European populations living in climates that are currently temperate. While the elderly and people living alone are particularly vulnerable to heat waves, no segment of the population may be considered protected from the risks associated with heat waves

Cause-specific mortality time series analysis: a general method to detect and correct for abrupt data production changes

<p>Abstract</p> <p>Background</p> <p>Monitoring the time course of mortality by cause is a key public health issue. However, several mortality data production changes may affect cause-specific time trends, thus altering the interpretation. This paper proposes a statistical method that detects abrupt changes ("jumps") and estimates correction factors that may be used for further analysis.</p> <p>Methods</p> <p>The method was applied to a subset of the AMIEHS (Avoidable Mortality in the European Union, toward better Indicators for the Effectiveness of Health Systems) project mortality database and considered for six European countries and 13 selected causes of deaths. For each country and cause of death, an automated jump detection method called Polydect was applied to the log mortality rate time series. The plausibility of a data production change associated with each detected jump was evaluated through literature search or feedback obtained from the national data producers.</p> <p>For each plausible jump position, the statistical significance of the between-age and between-gender jump amplitude heterogeneity was evaluated by means of a generalized additive regression model, and correction factors were deduced from the results.</p> <p>Results</p> <p>Forty-nine jumps were detected by the Polydect method from 1970 to 2005. Most of the detected jumps were found to be plausible. The age- and gender-specific amplitudes of the jumps were estimated when they were statistically heterogeneous, and they showed greater by-age heterogeneity than by-gender heterogeneity.</p> <p>Conclusion</p> <p>The method presented in this paper was successfully applied to a large set of causes of death and countries. The method appears to be an alternative to bridge coding methods when the latter are not systematically implemented because they are time- and resource-consuming.</p

[Gender differences in premature mortality and avoidable deaths]

OBJECTIVE: This paper aims to describe and to analyse disparities between men and women for "premature" mortality rates (deaths before 65 year-old). The study is particularly focused on "avoidable" causes of death. These types of deaths are greatly related to risk behaviours such as alcohol abuse, tobacco abuse or dangerous driving. Taking account of these indicators ("premature" and "avoidable" mortality) enables to study health status discrepancies by gender and to characterize specific public health issues in France including high rates of "premature" mortality and risk behaviours. METHODS: The analysis is based on exhaustive mortality data from 1980 to 1999 supplied by the Centre for epidemiology of medical causes of death (CepiDc-INSERM). Specific causes of death closely related to risk behaviours are classified as "avoidable": lung and upper airways cancers, cirrhosis, alcoholic psychosis, traffic accidents, aids and suicide. The contribution of these categories in the global male overmortality was assessed according to different demographic and geographic characteristics. RESULTS: Within "premature" mortality, males experience greater burden of "avoidable" mortality (sex-ratio: 4 versus 2). The gender differences are mainly due to injuries and suicides in the younger age groups and to tobacco and alcohol-related cancers (lung and upper airways) in the 45-64 years age group. The recent decline in "premature" mortality sex-ratio is explained by an increase of these two cancers for females. Among european countries, the French male overmortality is especially marked and mainly attributable to "avoidable" causes of death. CONCLUSION: "Avoidable" and "premature" mortality provide useful tools for the follow-up of health status in France particularly because of high risk behaviours and prevention inadequacy. Reducing gender discrepancies will depend mainly on public health policies in terms of primary prevention

Quality comparison of electronic versus paper death certificates in France, 2010

BACKGROUND: Electronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates. METHODS: All death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death. RESULTS: 533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates. CONCLUSION: The method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted

The impact of major heat waves on all-cause and cause-specific mortality in France from 1971 to 2003.

International audienceOBJECTIVES: The aim of the study was to identify the major heat waves (HW) that occurred in France from 1971 to 2003 and describe their impact on all-cause and cause-specific mortality. METHODS: Heat waves were defined as periods of at least three consecutive days when the maximum and the minimum temperature, averaged over the whole France, were simultaneously greater than their respective 95th percentile. The underlying causes of death were regrouped into 18 categories. Heatstroke, hyperthermia and dehydration were assigned to the "heat-related causes" (HRC) category. The numbers of deaths observed (O) during the identified HW were compared to those expected (E) on the basis of the mortality rates reported for the three preceding years. RESULTS: Six HW were identified from the period 1971 to 2003. They were associated with great excess mortality (from 1,300 to 13,700 deaths). The observations are compatible with a moderate harvesting effect for four of the six HW. The mortality ratios increased with age for subjects aged over 55 years and were higher for women than for men over 75 years. For the six HW, the excess mortality was significant for almost all the causes of death: (1) the greatest excess mortality (O-E) were observed for cardiovascular diseases, neoplasms, respiratory system diseases, HRC, ill-defined conditions and injury and poisoning, and (2) the mortality ratios (O/E) were highest for HRC, respiratory diseases, nervous system diseases, mental disorders, infectious diseases, and endocrine and nutritional diseases. CONCLUSIONS: Heat waves associated with excess mortality are not rare events in this temperate-climate country. The excess mortality is much greater than HRC mortality. Some populations are particularly vulnerable to HW: the elderly, women and people with some specific diseases. However, no segment of the population may be considered protected from the risks associated with HW