Avoidable heat-related mortality in China during the 21st century

Using non-accidental mortality records from 195 sites and 11 model simulations from the Coupled Model Intercomparison Project phase 6, we assessed future avoidable heat-related deaths associated with emission mitigation after accounting for population changes in China. Without human-induced climate change in the 21st century, China's heat-related mortality would drop by 48-72% (95% confidence interval (CI): 40-76%), especially at high latitudes and altitudes (up to 80%). Nationally, 15,576-87,612 (95% CI: 6605-106,736) heat-related deaths per year would potentially be avoided by reducing emissions. For most of China, temperature changes dominate the variation in heat-related deaths, while in Central and South China, population changes will have a greater influence. These not only reinforce the necessity of mitigating emissions but also suggest that adjusting population structure and spatial distribution could be applied in some areas to minimize warming impacts on public health. Notably, given that abatement will hardly bring immediate success within the next twenty years, more healthcare infrastructures are urgently needed to manage potential growing heat risks. Particularly in Northwest and South China, where future heat-related deaths would still be 110-140% of current levels (1995-2014) even without anthropogenic warming. We also found that without historical human-induced emissions, China's low level of technology (medical and economic) might increase current heat-related mortality by 57%, even though warming could be mitigated. Consequently, we believe that mitigating climate change risks also requires consideration of the economic/medical losses from lowering emissions.