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Liu, J.* ; Kim, H.* ; Hashizume, M.* ; Lee, W.* ; Honda, Y.* ; Kim, S.E.* ; He, C. ; Kan, H.* ; Chen, R.*

Nonlinear exposure-response associations of daytime, nighttime, and day-night compound heatwaves with mortality amid climate change.

Nat. Commun. 16:635 (2025)

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Heatwaves are commonly simplified as binary variables in epidemiological studies, limiting the understanding of heatwave-mortality associations. Here we conduct a multi-country study across 28 East Asian cities that employed the Cumulative Excess Heatwave Index (CEHWI), which represents excess heat accumulation during heatwaves, to explore the potentially nonlinear associations of daytime-only, nighttime-only, and day-night compound heatwaves with mortality from 1981 to 2010. Populations exhibited high adaptability to daytime-only and nighttime-only heatwaves, with non-accidental mortality risks increasing only at higher CEHWI levels (75th-90th percentiles). In contrast, compound heatwaves posed a super-linear increase in mortality risks after the 25th percentile of CEHWI. Associations of heatwaves with cardiovascular mortality mirrored those with non-accidental mortality but were more pronounced at higher CEHWI levels, while significant associations with respiratory mortality emerged at low-to-moderate CEHWI levels. These results highlight the necessity of considering the nonlinear health responses to heatwaves of different types in disease burden assessments and heatwave-health warning systems amid climate change.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Heat Waves; Excess Mortality; Temperature Extremes; Health; Events; Impact; Cities; Projections; Risk; Cold

ISSN (print) / ISBN 2041-1723

e-ISSN 2041-1723

Journal Nature Communications

Quellenangaben Volume: 16, Issue: 1, Article Number: 635

Publisher Nature Publishing Group

Publishing Place London

Non-patent literature Publications

Reviewing status Peer reviewed

Institute(s) Institute of Epidemiology (EPI)

Grants National Natural Science Foundation of China (National Science Foundation of China)
National Natural Science Foundation of China
Shanghai B&R Joint Laboratory Project
Shanghai Municipal Science and Technology Major Project
Shanghai International Science and Technology Partnership Project
Fudan University and Jiading District