The trends of non-accidental mortality burden attributed to compound hot-dry events in China and its provinces in a global warming world.

BACKGROUND

Global warming has provoked more co-occurrence of hot extreme and dry extreme, namely compound hot-dry events (CHDEs). However, their health impacts have seldom been investigated. This study aimed to characterize CHDEs and assess its mortality burden in China from 1990 to 2100.

METHODS

CHDEs were defined as a day when daily maximum temperature > its 90th percentile and Standardized Precipitation Index < its 50th percentile. A two-stage approach, including a distributed lag nonlinear model (DLNM) and a multivariate meta-analysis, was used to estimate exposure-response associations of CHDEs with mortality in 358 counties/districts during 2006-2017 in China, which was then applied to assess the national mortality burden attributable to CHDEs from 1990 to 2100.

FINDINGS

We observed a significant increasing trend of CHDEs in China until mid-21st century, and then flatted, while the duration and intensity of CHDEs continuously increased across the 21st century. CHDEs were much riskier (ER=17.82 %, 95 %CI: 14.17 %-21.60 %) than independent hot events (ER=5.86 %,95 %CI: -0.04 %,12.45 %) or dry events (ER=0.07 %,95 %CI: -1.22 %, 1.38 %), and there was significantly additive interaction between hot events and dry events (AP=0.10,95 %CI: 0.04, 0.16). Females (ER=24.28 %, 95 %CI: 19.21 %-29.56 %), the elderly (ER=23.28 %, 95 %CI: 18.23 %-28.55 %), and people living in humid area (ER=18.98 %, 95 %CI: 15.08 %-23.02 %) had higher mortality risks than their counterparts. Mortality burden attributed to CHDEs significantly increased during historical observation and became stable since mid-21st century in China.

INTERPRETATION

CHDEs would significantly increase mortality with higher risk for females, the elderly and people living in humid areas. Mortality burden has significantly increased during historical observation and will keep relatively steady since mid-21st century.