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Multicenter Study
. 2025 Aug;11(31):eadr0800.
doi: 10.1126/sciadv.adr0800. Epub 2025 Aug 1.

Hospitalization risk and burden for cause-specific cardiovascular diseases following tropical cyclones: A multicountry study

Wenzhong Huang  1 , Zhengyu Yang  1 , Yiwen Zhang  1 , Thomas Vogt  2 , Jinah Park  3 , Wenhua Yu  1 , Rongbin Xu  1   4 , Simon Hales  5 , Samuel Hundessa  1 , Christian Otto  2 , Pei Yu  1 , Yanming Liu  1 , Ke Ju  1 , Eric Lavigne  6   7 , Tingting Ye  1 , Bo Wen  1 , Yao Wu  1 , Yuxi Zhang  8 , Wissanupong Kliengchuay  9 , Kraichat Tantrakarnapa  9 , Yue Leon Guo  10   11   12 , Ho Kim  3   13 , Dung Phung  14 , Elizabeth A Ritchie  15   16 , Shanshan Li  1 , Yuming Guo  1
Affiliations
Multicenter Study

Hospitalization risk and burden for cause-specific cardiovascular diseases following tropical cyclones: A multicountry study

Wenzhong Huang et al. Sci Adv. 2025 Aug.

Abstract

The indirect health risks of tropical cyclones (TCs), the costliest climate extremes, remain unclear, with cardiovascular diseases (CVDs) being a major contributor. We applied two-stage time-series analysis to 6.54 million CVD hospitalizations across six countries/territories (Canada, New Zealand, South Korea, Taiwan, Thailand, and Vietnam) between 2000 and 2019 to quantify the long-term risks and burden of CVD hospitalizations following TCs. Hospitalization risks for cause-specific CVDs consistently increased following TC exposure, generally peaking around 2 months postexposure and dissipating by 6 months. Overall, each additional TC day was associated with a 13% (95% confidence interval, 7 to 19%) increase in CVD hospitalizations in 6 months following TCs. Particularly high TC-attributable burden was found for ischemic heart diseases and stroke, especially among males, individuals aged 20 to 59 years, and those with higher levels of socioeconomic deprivation. The TC-attributable proportions of CVD hospitalizations showed decreasing trends in less deprived populations and increasing trends in more deprived populations from 2000 to 2019.

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Figures

Fig. 1.
Fig. 1.. Bivariate plot of counts of TC exposure days and CVD hospitalizations per decade in Canada, South Korea, New Zealand, Vietnam, Thailand, and Taiwan during the study period.
Fig. 2.
Fig. 2.. Overall RRs of hospitalizations for cause-specific CVDs for each additional TC day along 0 to 12 months after TC exposure.
The shaded area indicates the 95% CI.
Fig. 3.
Fig. 3.. CumRR of CVD hospitalizations for each additional cyclone day defined with different thresholds of maximum sustained windspeed (knots) over 6 months after the exposure.
Different curves were estimated on the basis of models with varying degrees of freedom (df) for the year (dfyear), month (dfmonth), and temperature (dftemp) or a model without the adjustment of temperature (without temp). The bold red line indicates the effect estimates produced by the main model.
Fig. 4.
Fig. 4.. Overall and subgroup-specific cumRRs of hospitalizations for cause-specific CVDs for each additional TC day over 6 months after the exposure, stratified by sex, age, RDI, and country/territory.
*P for the between-group difference was <0.05.
Fig. 5.
Fig. 5.. Temporal evolution of the percentages (%, with 95% CI) of cause-specific CVD hospitalizations attributable to TC exposures by RDI tertiles.
The attributable fractions were calculated on the basis of period-specific TC-associated CVD hospitalization risks.
Fig. 6.
Fig. 6.. Flow diagram of data collection and organization procedures.
Abbreviations: ICD, International Classification of Diseases; MoPH, Ministry of Public Health; NHIRD, National Health Insurance Research Database; NHIS-NSC, National Health Insurance Service-National Sample Cohort.
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