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A Retrospective Study on Heat-Related Mortality in an Elderly Population During the 2003 Heat Wave in Modena, Italy: The Argento Project

¹ Geriatrics, University of Modena and Reggio Emilia, Italy.
² Epidemiology and Statistical Service, District 3, Azienda Unità Sanitaria Locale of Modena, Italy.
³ Municipality of Modena, Demographic Service Department, Italy.
⁴ ARPA (Regional Agency for Environmental Prevention in Emilia-Romagna), Italy.
⁵ District 3, Azienda Unità Sanitaria Locale of Modena, Italy.
⁶ Federazione Italiana Medici Medicina Generale (FIMMG), Rome, Italy.

Address correspondence to Chiara Mussi, MD, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, Via Giardini 1135, 41100 Baggiovara di Modena, Italy. E-mail: cmussi{at}iol.it

Background. Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August).

Methods. We performed a retrospective, case–control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed.

Results. Cases were more likely to be living in a nursing home and needing assistance (p =.024, and p <.001, respectively). Survivors were living on higher level floors (p =.046). Spending the summer in Modena was significantly related to poor outcomes (p <.01). A higher number of cases were using public health services (p <.001). Individuals who died had a greater degree of comorbidity and dependence (p <.001); they were cognitively impaired (p <.001), took a larger number of drugs (p <.001), and had a greater number of hospital admissions (p <.001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death.

Conclusions. Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.