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Keywords
Abstract	Background: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. Methods: Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. Results: The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. Conclusions: Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.
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Name	Affiliation	Home page	e-mail	Total pubs
Analitis A	Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece			1
Atkinson R	Division of Community Health Sciences, St. George's University, London, UK			1
Bisanti L	Azienda Sanitaria Locale della Citta di Milano, Servizio di Epidemiologia, Corso Italia, 19, 20122 Milano, Italy		lbisanti@asl.milano.it	3
De-Donato F	Department of Epidemiology, Regional Health Authority, Rome, Italy			1
D-Ippoliti D	Department of Epidemiology, Regional Health Authority, Rome, Italy		dippoliti@asplazio.it	1
Iniguez C	Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Doctor Aiguader 88, 08003, Barcelona, Spain			3
Katsouyanni K	Department of Hygiene and Epidemiology, University of Athens Medical School, Greece		kkatsoug@cc.uoa.gr	5
Kirchmayer U	Department of Epidemiology Local Health Authority Roma E, Rome, Italy		kirchmayer@asplazio.it	2
Kovats S	Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, London, UK			2
Lefranc A	Department of Environmental Health, French Institute for Public Health Surveillance, Saint Maurice, Cedex France			1
Marino C	Department of Epidemiology, Local Health Authority Rome E, Rome, Italy		marino@asplazio.it	2
Medina-Ramon M	Centre for Research in Environmental Epidemiology, Barcelona, Catalonia, Spain			1
Menne B	WHO, Regional Office for Europe, Rome, Italy		bme@ecr.euro.who.int	2
Michelozzi P	Department of Environment and Primary Prevention, Istituto Superiore di Sanita, Viale Regina Elena 299 00161 Rome, Italy		michelozzi@asplazio.it	4
Paldy A	ozsef Fodor National Centre of Public Health, National Institute of Environmental Health, Department of Biological Monitorino, Gyali ut 2-6, PO.Box. 64, 1097 Budapest, Hungary		paldya@okk.antsz.hu	2
Perucci CA	Department of Epidemiology, Local Health Authority Rome E, Rome, Italy		perucci@asplazio	6
Schneider A	Helmholtz Zentrum Munchen, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany			2