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. 2024 Jan 22;21(1):e1004341.
doi: 10.1371/journal.pmed.1004341. eCollection 2024 Jan.

Tropical cyclone-specific mortality risks and the periods of concern: A multicountry time-series study

Wenzhong Huang  1 , Zhengyu Yang  1 , Yiwen Zhang  1 , Thomas Vogt  2 , Ben Armstrong  3 , Wenhua Yu  1 , Rongbin Xu  1 , Pei Yu  1 , Yanming Liu  1 , Antonio Gasparrini  3   4   5 , Samuel Hundessa  1 , Eric Lavigne  6   7 , Tomas Molina  8 , Tobias Geiger  9 , Yue Leon Guo  10   11   12 , Christian Otto  2 , Simon Hales  13 , Farnaz Pourzand  13 , Shih-Chun Pan  11 , Ke Ju  1 , Elizabeth A Ritchie  14   15 , Shanshan Li  1 , Yuming Guo  1 ; MCC Collaborators
Affiliations

Tropical cyclone-specific mortality risks and the periods of concern: A multicountry time-series study

Wenzhong Huang et al. PLoS Med. .

Abstract

Background: More intense tropical cyclones (TCs) are expected in the future under a warming climate scenario, but little is known about their mortality effect pattern across countries and over decades. We aim to evaluate the TC-specific mortality risks, periods of concern (POC) and characterize the spatiotemporal pattern and exposure-response (ER) relationships on a multicountry scale.

Methods and findings: Daily all-cause, cardiovascular, and respiratory mortality among the general population were collected from 494 locations in 18 countries or territories during 1980 to 2019. Daily TC exposures were defined when the maximum sustained windspeed associated with a TC was ≥34 knots using a parametric wind field model at a 0.5° × 0.5° resolution. We first estimated the TC-specific mortality risks and POC using an advanced flexible statistical framework of mixed Poisson model, accounting for the population changes, natural variation, seasonal and day of the week effects. Then, a mixed meta-regression model was used to pool the TC-specific mortality risks to estimate the overall and country-specific ER relationships of TC characteristics (windspeed, rainfall, and year) with mortality. Overall, 47.7 million all-cause, 15.5 million cardiovascular, and 4.9 million respiratory deaths and 382 TCs were included in our analyses. An overall average POC of around 20 days was observed for TC-related all-cause and cardiopulmonary mortality, with relatively longer POC for the United States of America, Brazil, and Taiwan (>30 days). The TC-specific relative risks (RR) varied substantially, ranging from 1.04 to 1.42, 1.07 to 1.77, and 1.12 to 1.92 among the top 100 TCs with highest RRs for all-cause, cardiovascular, and respiratory mortality, respectively. At country level, relatively higher TC-related mortality risks were observed in Guatemala, Brazil, and New Zealand for all-cause, cardiovascular, and respiratory mortality, respectively. We found an overall monotonically increasing and approximately linear ER curve of TC-related maximum sustained windspeed and cumulative rainfall with mortality, with heterogeneous patterns across countries and regions. The TC-related mortality risks were generally decreasing from 1980 to 2019, especially for the Philippines, Taiwan, and the USA, whereas potentially increasing trends in TC-related all-cause and cardiovascular mortality risks were observed for Japan.

Conclusions: The TC mortality risks and POC varied greatly across TC events, locations, and countries. To minimize the TC-related health burdens, targeted strategies are particularly needed for different countries and regions, integrating epidemiological evidence on region-specific POC and ER curves that consider across-TC variability.

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Conflict of interest statement

YG is a member of the Editorial Board of PLOS Medicine. All other authors declare no competing interests.

Figures

Fig 1
Fig 1. The spatial distribution and number of exposed TCs of the 494 study locations.
. The base layer of the world map was imported from the public domain Natural Earth project (source: https://www.naturalearthdata.com/downloads/; terms of use: www.naturalearthdata.com/about/terms-of-use/). TC, tropical cyclone.
Fig 2
Fig 2. The top 100 TCs with highest excess deaths from all-cause, CVDs, and RDs.
Each point in the figure indicates a location, and each tick on the X-axis represents a TC, which is identified by its IBTrACS event ID. A boxplot was fitted for the location-specific TC-related excess deaths within each TC. Each box represents the IQR of the excess deaths of each TC, with the middle bolded black line in the box representing the median value. The whiskers extending from the box indicate a range of 1.5 times the IQR. CVD, cardiovascular disease; IQR, interquartile range; RD, respiratory disease; TC, tropical cyclone.
Fig 3
Fig 3. The top 100 TCs with highest RR for all-cause, CVDs, and RDs mortality.
The RRs were estimated by comparing the deaths on TC-exposed days with those on non-exposed days, after adjusting for population changes, natural variation, seasonal, and day of the week effects. CVD, cardiovascular disease; RD, respiratory disease; RR, relative risk; TC, tropical cyclone.
Fig 4
Fig 4. Country or territory-specific overall RR with 95% CI for all-cause, CVDs, and RDs mortality associated with TC exposure.
The RRs indicated the mortality risks in TC days compared to non-TC days. CI, confidence interval; CVD, cardiovascular disease; RD, respiratory disease; RR, relative risk; TC, tropical cyclone.
Fig 5
Fig 5. The exposure-response relationship of the RR for all-cause, CVDs, and RDs mortality with TC-related maximum sustained windspeed (knots) by countries or territories.
The RRs indicated the mortality risks in TC days compared to non-TC days. CVD, cardiovascular disease; RD, respiratory disease; RR, relative risk; TC, tropical cyclone.
Fig 6
Fig 6. The temporal trends of the RR for all-cause, CVDs, and RDs mortality by countries or territories from 1980 to 2019.
The RRs indicated the mortality risks in TC days compared to non-TC days. CVD, cardiovascular disease; RD, respiratory disease; RR, relative risk; TC, tropical cyclone.
See this image and copyright information in PMC

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