The relation between temperature, ozone, and mortality in nine french cities during the heat wave of 2003

BACKGROUND: During August 2003, record high temperatures were observed across Europe, and France was the country most affected. During this period, elevated ozone concentrations were measured all over the country. Questions were raised concerning the contribution of O-3 to the health impact of the summer 2003 heat wave. METHODS: We used a time-series design to analyze short-term effects of temperature and O-3 pollution on mortality. Counts of deaths were regressed on temperatures and O-3 levels, controlling for possible confounders: long-term trends, season, influenza outbreaks, day of the week, and bank holiday effects. For comparison with previous results of the nine cities, we calculated pooled excess risk using a random effect approach and an empirical Bayes approach. FINDINGS: For the nine cities, the excess risk of death is significant (1.01%; 95% confidence interval, 0.58-1.44) for an increase of 10 mu g/m(3) in O-3 level. For the 3-17 August 2003 period, the excess risk of deaths linked to O-3 and temperatures together ranged from 10.6% in Le Havre to 174.7% in Paris. When we compared the relative contributions Of O-3 and temperature to this joint excess risk, the contribution of O-3 varied according to the city, ranging from 2.5% in Bordeaux to 85.3% in Toulouse. INTERPRETATION: We observed heterogeneity among the nine cities not only for the joint effect of O-3 and temperatures, but also for the relative contribution of each factor. These results confirmed that in urban areas O-3 levels have a non-negligible impact in terms of public health.