Excess male mortality and age-specific mortality trajectories under different mortality conditions: a lesson from the heat wave of summer 2003

INTRODUCTION: Our objective was to study the impact of an identical additional stress on male and female mortality with a quasi-experimental study design, using natural variations in summer mortality, including the massive heat wave that struck Europe in 2003. MATERIAL AND METHODS: The summer daily mortality rates of the population aged 65 and over living in 16 European countries were computed by single age from 1998 to 2003. Using the method of Tukey, we established five categories summarizing the summer daily conditions of mortality (exceptionally high values, minor extremely high values, common values, minor extremely low values, and exceptionally low values). RESULTS: Whatever the mortality conditions during the summer months, the mortality trajectories by age are exponential for both sexes: males die twice more than females at the age of 65 and their level of mortality linearly converges around the age of 97 to that of the females. DISCUSSION: Being male remains a major risk factor of mortality during heat waves. This issue was missed by previous epidemiological studies because almost all of them focused only on the relative increase in mortality and not on the sex specific mortality rates which implies being able to estimate the population at risk