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

Jiangdong Liu, Ho Kim, Masahiro Hashizume, Whanhee Lee, Yasushi Honda, Satbyul Estella Kim, Cheng He, Haidong Kan () and Renjie Chen ()
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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
Satbyul Estella Kim: National Institute for Environmental Studies
Cheng He: Helmholtz Zentrum München–German Research Center for Environmental Health
Haidong Kan: Fudan University
Renjie Chen: Fudan University

Nature Communications, 2025, vol. 16, issue 1, 1-12

Abstract: 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.

Date: 2025
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DOI: 10.1038/s41467-025-56067-7

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