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. 2024 Feb:184:108461.
doi: 10.1016/j.envint.2024.108461. Epub 2024 Jan 26.

Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study

Jeroen de Bont  1 , Amruta Nori-Sarma  2 , Massimo Stafoggia  3 , Tirthankar Banerjee  4 , Vijendra Ingole  5 , Suganthi Jaganathan  6 , Siddhartha Mandal  7 , Ajit Rajiva  7 , Bhargav Krishna  8 , Itai Kloog  9 , Kevin Lane  2 , Rajesh K Mall  10 , Abhiyant Tiwari  11 , Yaguang Wei  12 , Gregory A Wellenius  2 , Dorairaj Prabhakaran  7 , Joel Schwartz  12 , Poornima Prabhakaran  7 , Petter Ljungman  13
Affiliations

Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study

Jeroen de Bont et al. Environ Int. 2024 Feb.

Abstract

Background: Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world's largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable mortality fraction in India.

Methods: We obtained all-cause mortality counts for ten cities in India (2008-2019) and estimated daily mean temperatures from satellite data. Our main extreme heatwave was defined as two-consecutive days with an intensity above the 97th annual percentile. We estimated city-specific heatwave associations through generalised additive Poisson regression models, and meta-analysed the associations. We reported effects as the percentage change in daily mortality, with 95% confidence intervals (CI), comparing heatwave vs non-heatwave days. We further evaluated heatwaves using different percentiles (95th, 97th, 99th) for one, two, three and five-consecutive days. We also evaluated the influence of heatwave duration, intensity and timing in the summer season on heatwave mortality, and estimated the number of heatwave-related deaths.

Findings: Among ∼ 3.6 million deaths, we observed that temperatures above 97th percentile for 2-consecutive days was associated with a 14.7 % (95 %CI, 10.3; 19.3) increase in daily mortality. Alternative heatwave definitions with higher percentiles and longer duration resulted in stronger relative risks. Furthermore, we observed stronger associations between heatwaves and mortality with higher heatwave intensity. We estimated that around 1116 deaths annually (95 %CI, 861; 1361) were attributed to heatwaves. Shorter and less intense definitions of heatwaves resulted in a higher estimated burden of heatwave-related deaths.

Conclusions: We found strong evidence of heatwave impacts on daily mortality. Longer and more intense heatwaves were linked to an increased mortality risk, however, resulted in a lower burden of heatwave-related deaths. Both definitions and the burden associated with each heatwave definition should be incorporated into planning and decision-making processes for policymakers.

Keywords: Attributable deaths; Climate change; Heatwaves; India; Mortality.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Study cities in India according to a simplified Köppen-Geiger climate zone classification. Footnote: this is a derivative map from the Köppen Geiger classification(Beck et al., 2018). We removed some of the categories which were in small quantity and were not possible to significantly differentiate enough (e.g. Temperate, dry winter, warm summer was subsumed into Temperate, dry winter, hot summer).
Fig. 2.
Fig. 2.
Pooled estimates of the percent increase (95% CI) in mortality risk due to multiple heatwaves definitions (numeric effect estimates are shown in Table S1) Abbreviation: HW, heatwave. Note: Estimates are provided as percentage change in mortality and 95% confidence interval comparing heatwaves vs non-heatwave days. Models were adjusted for a penalized spline smooth function of calendar day with nine degrees of freedom (df), an indicator of day-of-week, a natural spline function with 4 df for adjusted dew point temperature (lag 0–1, and air pollution (lag 0–1). Heatwaves above the 99th percentile for 5 consecutive days was estimated including 6 cities (Ahmedabad, Chennai, Delhi, Hyderabad, Kolkata, Varanasi).
Fig. 3.
Fig. 3.
Comparison of attributable deaths across different heatwave definitions.
See this image and copyright information in PMC

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