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Nonlinear exposure-response associations of daytime, nighttime, and day-night compound heatwaves with mortality amid climate change

Author

Listed:
  • Jiangdong Liu

    (Fudan University)

  • Ho Kim

    (Seoul National University)

  • Masahiro Hashizume

    (The University of Tokyo)

  • Whanhee Lee

    (Pusan National University)

  • Yasushi Honda

    (National Institute for Environmental Studies
    University of Tsukuba)

  • Satbyul Estella Kim

    (National Institute for Environmental Studies
    University of Tsukuba)

  • Cheng He

    (Helmholtz Zentrum München–German Research Center for Environmental Health)

  • Haidong Kan

    (Fudan University
    National Center for Children’s Health)

  • Renjie Chen

    (Fudan University)

Abstract

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.

Suggested Citation

  • Jiangdong Liu & Ho Kim & Masahiro Hashizume & Whanhee Lee & Yasushi Honda & Satbyul Estella Kim & Cheng He & Haidong Kan & Renjie Chen, 2025. "Nonlinear exposure-response associations of daytime, nighttime, and day-night compound heatwaves with mortality amid climate change," Nature Communications, Nature, vol. 16(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-56067-7
    DOI: 10.1038/s41467-025-56067-7
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