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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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