The effects of night-time warming on mortality burden under future climate change scenarios: a modelling study

Background The health impacts of climate warming are usually quantified based on daily average temperatures. However, extra health risks might result from hot nights. We project the future mortality burden due to hot nights. Methods We selected the hot night excess (HNE) to represent the intensity of night-time heat, which was calculated as the excess sum of high temperature during night time. We collected historical mortality data in 28 cities from three east Asian countries, from 1981 to 2010. The associations between HNE and mortality in each city were firstly examined using a generalised additive model in combination with a distributed lag non-linear model over lag 0-10 days. We then pooled the cumulative associations using a univariate meta-regression model at the national or regional levels. Historical and future hourly temperature series were projected under two scenarios of greenhousegas emissions from 1980-2099, with ten general circulation models. We then projected the attributable fraction of mortality due to HNE under each scenario. Findings Our dataset comprised 28 cities across three countries (Japan, South Korea, and China), including 9 185 598 deaths. The time-series analyses showed the HNE was significantly associated with increased mortality risks, the relative mortality risk on days with hot nights could be 50% higher than on days with non-hot nights. Compared with the rise in daily mean temperature (lower than 20%), the frequency of hot nights would increase more than 30% and the intensity of hot night would increase by 50% by 2100s. The attributable fraction of mortality due to hot nights was projected to be 3.68% (95% CI 1.20 to 6.17) under a strict emission control scenario (SSP126). Under a medium emission control scenario (SSP245), the attributable fraction of mortality was projected to increase up to 5.79% (2.07 to 9.52), which is 0.95% (-0.39 to 2.29) more than the attributable fraction of mortality due to daily mean temperature. Interpretation Our study provides evidence for significant mortality risks and burden in association with night-time warming across Japan, South Korea, and China. Our findings suggest a growing role of night-time warming in heat-related health effects in a changing climate. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.