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PLoS Med. 2018 Jul 31;15(7):e1002629. doi: 10.1371/journal.pmed.1002629. eCollection 2018 Jul.

Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study.

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Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil.
Faculty of Sciences, University of Technology Sydney, Sydney, Australia.
School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada.
Health Impact Assessment Division, Department of Health, Ministry of Public Health, Muang Nonthaburi, Thailand.
Laboratory of Management in Public Health, Chisinau, Republic of Moldova.
Department of Public Health, Universidad de los Andes, Santiago, Chile.
Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China.
Department of Environmental Health, University of São Paulo, São Paulo, Brazil.
Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
School of Physics, Dublin Institute of Technology, Dublin, Ireland.
Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
Department of Environmental Engineering, Kyoto University, Kyoto, Japan.
Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain.
Epidemiology and Environmental Health Joint Research Unit, University of Valencia, Valencia, Spain.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.
School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, United States of America.
Center for Health and the Global Environment, University of Washington, Seattle, Washington, United States of America.
School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China.
Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.



Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.


We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.


This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

[Indexed for MEDLINE]
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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: MLB has received research grants from NIH and EPA, and travel expenses paid by universities and research institutions in order to give seminars and participate in research meetings. All other authors have declared that no competing interests exist.

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