Zusammenfassung
HINTERGRUND: Der heiße Sommer 2003 mit erhöhten Sterberaten in Süd- und Westeuropa rückte die gesundheitliche Bedeutung von Hitzewellen in den Blickpunkt. Zu Auswirkungen von Hitzewellen auf die Sterblichkeit in Österreich gab es bisher noch keine Untersuchungen. METHODE: Daten zur täglichen Mortalität in Wien im Zeitraum von 1998 bis 2004 wurden von Statistik Austria, meteorologische Daten von der Zentralanstalt für Meteorologie und Geodynamik zur Verfügung gestellt. Zur Definition von Hitzewellen wurden die Kysely-Kriterien herangezogen. Die tägliche Sterblichkeit von Mai bis September wurde mittels "Generalized Additive Model" (Poisson-Regression und log link) unter Berücksichtigung von "Over-Dispersion" analysiert. Der jahreszeitliche Trend wurde über Splines, Wochentage mittels Dummies modelliert. Hitzetage wurden als dichotome Prädiktoren inkludiert. ERGEBNISSE: In den letzten 35 Jahren stieg die durchschnittliche Temperatur (Mai bis September) in Wien um über 1,7 °C. Im Jahr 2003 zeigte sich eine Zunahme der Hitzetage auf insgesamt 44, die mit einer erhöhten Anzahl von Todesfällen einhergingen. Von diesen rund 180 Todesfällen war der Großteil nicht einem "Harvesting-Effekt" zuzurechnen. Es fand sich im Zeitraum 1998 bis 2004 an den Hitzetagen ein signifikant erhöhtes relatives Mortalitätsrisiko von 1,13 [95% Konfidenzintervall 1,09–1,17]. Diese Risikoerhöhung war bei Frauen deutlicher als bei Männern ausgeprägt. Obwohl die Sterblichkeitszunahme in allen Altersgruppen beobachtet werden konnte, waren die Ergebnisse nur bei älteren Personen (> 65 Jahre) signifikant. DISKUSSION: Auch wenn die Folgen der Hitzewellen nicht so ausgeprägt waren wie in Frankreich und Südwesteuropa, war in Wien im Sommer 2003 die tägliche Sterblichkeit erhöht. Zumindest 130 Todesfälle hätten in diesem Jahr durch prompte medizinische Hilfe und rechtzeitige Aufklärung der Risikogruppen zum Verhalten bei extremer Hitze verhindert werden können. Die Häufigkeit extremer Hitze-Episoden wird voraussichtlich als Folge der globalen Erwärmung zunehmen. Speziell auf die ältere Bevölkerung ausgerichtete Vorsorgeprogramme sind daher erforderlich.
Summary
BACKGROUND: The hot summer of 2003 brought about increased mortality in southern and western Europe, highlighting the health impact of heatwaves. No Austrian mortality data have yet been reported for this summer period. METHODS: Daily mortality data for Vienna between 1998 and 2004 were obtained from Statistics Austria and meteorological data from the Austrian Central Institute for Meteorology and Geodynamics. Heatwaves were defined using the Kysely criterion. Daily mortality for May to September was predicted by a generalized additive model considering over-dispersion with Poisson deviates and a log link. Seasonal trend was accounted for by a natural spline, weekdays were modeled by dummy variables and heatwave days were included as dichotomous predictor. RESULTS: The average seasonal temperature for May to September in Vienna has increased by more than 1.7 °C during the last 35 years. In 2003 there was an excess of heatwave days, 44 overall, that resulted in an increased number of deaths, approximately 180, most of which were not due to 'harvesting'. Heatwave days between 1998 and 2004 were associated with a significantly increased relative mortality risk of 1.13 [95% confidence interval 1.09–1.17]. This increase was stronger in females than in males. Although excess mortality was seen in all age groups, it reached significance only in the elderly population over 65 years. DISCUSSION: An impact of heatwaves on mortality was apparent in Vienna, although not as pronounced as in France and south-western Europe. In 2003 at least 130 heatwave-related deaths in Vienna could have been avoided by prompt medical assistance and proper advice about how to cope with excessive thermal conditions. Preventive programs are warranted during heatwaves, especially to target elderly people, because the likelihood of heatwaves as a consequence of global warming is increasing.
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