Heat-Related Mortality/Morbidity in East Asia

  • Yasushi HondaEmail author
  • Daisuke Onozuka


Heat causes (or exacerbates) various illness, including heat stroke, circulatory diseases, respiratory diseases, infectious diseases, accidents and suicides. Because of these diverse impacts on health, we evaluated heat-related excess mortality using all-cause mortality as the outcome and statistical model in its definition; the excess risk beyond the minimum mortality temperature (=MMT) is regarded as the heat-related excess mortality. Based on the whole Japanese data for about 4 decades of observation, we found the MMT can be estimated using 84th percentile of daily maximum temperature. Using this finding, we performed a projection of heat-related excess mortality; with no adaptation, the world’s heat-related excess deaths attributable to climate change was more than 90,000 in 2030 and 255,000 in 2050. Autonomous adaptation, i.e., MMT shift along with warming, has been observed in some countries; we also took this phenomenon into account. With the autonomous adaptation, the future impact would be smaller, but the speed of adaptation is still unknown, and further research is needed.


Excess mortality Minimum mortality temperature Distributed lag nonlinear model Future projection General circulation model Adaptation 



This chapter is based on some studies supported by the Environment Research and Technology Development Fund (S-14) of the Environmental Restoration and Conservation Agency.


  1. Armstrong, B. (2006). Models for the relationship between ambient temperature and daily mortality. Epidemiology, 17(6), 624–631. Scholar
  2. Bai, L., Ding, G., Gu, S., Bi, P., Su, B., Qin, D., et al. (2014). The effects of summer temperature and heat waves on heat-related illness in a coastal city of China, 2011–2013. Environmental Research, 132, 212–219. Scholar
  3. Chan, E. Y., Goggins, W. B., Kim, J. J., Griffiths, S., & Ma, T. K. (2011). Help-seeking behavior during elevated temperature in Chinese population. Journal of Urban Health, 88(4), 637–650. Scholar
  4. Chan, E. Y., Goggins, W. B., Yue, J. S., & Lee, P. (2013). Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China. Bulletin of the World Health Organization, 91(8), 576–584. Scholar
  5. Chan, E. Y. Y., Lam, H. C. Y., So, S. H. W., Goggins, W. B., Ho, J. Y., Liu, S., & Chung, P. P. W. (2018). Association between ambient temperatures and mental disorder hospitalizations in a subtropical city: A time-series study of Hong Kong special administrative region. International Journal of Environmental Research and Public Health, 15(4). Scholar
  6. Chen, R., Li, T., Cai, J., Yan, M., Zhao, Z., & Kan, H. (2014). Extreme temperatures and out-of-hospital coronary deaths in six large Chinese cities. Journal of Epidemiology and Community Health, 68(12), 1119–1124. Scholar
  7. Cheng, Q., Bai, L., Zhang, Y., Zhang, H., Wang, S., Xie, M., et al. (2018). Ambient temperature, humidity and hand, foot, and mouth disease: A systematic review and meta-analysis. Science of the Total Environment, 625, 828–836. Scholar
  8. Cheng, J., Xie, M. Y., Zhao, K. F., Wu, J. J., Xu, Z. W., Song, J., et al. (2017). Impacts of ambient temperature on the burden of bacillary dysentery in urban and rural Hefei, China. Epidemiology and Infection, 145(8), 1567–1576. Scholar
  9. Cheng, J., Xu, Z., Zhao, D., Xie, M., Zhang, H., Wang, S., & Su, H. (2016). The burden of extreme heat and heatwave on emergency ambulance dispatches: A time-series study in Huainan, China. Science of the Total Environment, 571, 27–33. Scholar
  10. Cho, E. J., Shin, S. D., Jeong, S., Kwak, Y. H., & Suh, G. J. (2016). The effect of atmosphere temperature on out-of-hospital cardiac arrest outcomes. Resuscitation, 109, 64–70. Scholar
  11. Chung, Y., Noh, H., Honda, Y., Hashizume, M., Bell, M. L., Guo, Y. L., & Kim, H. (2017). Temporal changes in mortality related to extreme temperatures for 15 cities in Northeast Asia: Adaptation to heat and maladaptation to cold. American Journal of Epidemiology, 185(10), 907–913. Scholar
  12. Curriero, F. C., Heiner, K. S., Samet, J. M., Zeger, S. L., Strug, L., & Patz, J. A. (2002). Temperature and mortality in 11 cities of the eastern United States. American Journal of Epidemiology, 155(1), 80–87.CrossRefGoogle Scholar
  13. Dang, T. N., Seposo, X. T., Duc, N. H., Thang, T. B., An, D. D., Hang, L. T., et al. (2016). Characterizing the relationship between temperature and mortality in tropical and subtropical cities: A distributed lag non-linear model analysis in Hue, Viet Nam, 2009–2013. Global Health Action, 9, 28738. Scholar
  14. Dang, T. N., Van, D. Q., Kusaka, H., Seposo, X. T., & Honda, Y. (2018). Green space and deaths attributable to the urban heat island effect in Ho Chi Minh City. American Journal of Public Health, 108(S2), S137–S143. Scholar
  15. Fukuda, T., Ohashi, N., Doi, K., Matsubara, T., Kitsuta, Y., Nakajima, S., & Yahagi, N. (2014). Impact of seasonal temperature environment on the neurologic prognosis of out-of-hospital cardiac arrest: A nationwide, population-based cohort study. Journal of Critical Care, 29(5), 840–847. Scholar
  16. Gasparrini, A., Armstrong, B., Kovats, S., & Wilkinson, P. (2012). The effect of high temperatures on cause-specific mortality in England and Wales. Occupational and Environmental Medicine, 69(1), 56–61. Scholar
  17. Gasparrini, A., Guo, Y., Hashizume, M., Kinney, P. L., Petkova, E. P., Lavigne, E., et al. (2015a). Temporal variation in heat-mortality associations: A multicountry study. Environmental Health Perspectives, 123(11), 1200–1207. Scholar
  18. Gasparrini, A., Guo, Y., Hashizume, M., Lavigne, E., Tobias, A., Zanobetti, A., et al. (2016). Changes in susceptibility to heat during the summer: A multicountry analysis. American Journal of Epidemiology, 183(11), 1027–1036. Scholar
  19. Gasparrini, A., Guo, Y., Hashizume, M., Lavigne, E., Zanobetti, A., Schwartz, J., et al. (2015b). Mortality risk attributable to high and low ambient temperature: A multicountry observational study. The Lancet, 386(9991), 369–375. Scholar
  20. Gasparrini, A., Guo, Y., Sera, F., Vicedo-Cabrera, A. M., Huber, V., Tong, S., et al. (2017). Projections of temperature-related excess mortality under climate change scenarios. Lancet Planet Health, 1(9), e360–e367. Scholar
  21. Ghazani, M., FitzGerald, G., Hu, W., Toloo, G. S., & Xu, Z. (2018). Temperature variability and gastrointestinal infections: A review of impacts and future perspectives. International Journal of Environmental Research and Public Health, 15(4). Scholar
  22. Gu, S., Huang, C., Bai, L., Chu, C., & Liu, Q. (2016). Heat-related illness in China, summer of 2013. International Journal of Biometeorology, 60(1), 131–137. Scholar
  23. Guo, T., Wang, Y., Zhang, H., Zhang, Y., Zhao, J., Wang, Y., et al. (2018). The association between ambient temperature and the risk of preterm birth in China. Science of the Total Environment, 613–614, 439–446. Scholar
  24. Hales, S., Kovats, S., Lloyd, S., & Campbell-Lendrum, D. (Eds.). (2014). Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva, Switzerland: World Health Organization.Google Scholar
  25. Han, M. H., Yi, H. J., Kim, Y. S., & Kim, Y. S. (2015). Effect of seasonal and monthly variation in weather and air pollution factors on stroke incidence in Seoul, Korea. Stroke, 46(4), 927–935. Scholar
  26. Honda, Y., Kondo, M., McGregor, G., Kim, H., Guo, Y. L., Hijioka, Y., et al. (2014). Heat-related mortality risk model for climate change impact projection. Environmental Health and Preventive Medicine, 19(1), 56–63. Scholar
  27. Honda, Y., Ono, M., Sasaki, A., & Uchiyama, I. (1995). Relationship between daily high temperature and mortality in Kyushu, Japan. Nihon Koshu Eisei Zasshi, 42(4), 260–268.Google Scholar
  28. Huang, J., Chen, S., Wu, Y., Tong, Y., Wang, L., Zhu, M., et al. (2018). Quantifying the influence of temperature on hand, foot and mouth disease incidence in Wuhan, Central China. Scientific Reports, 8(1), 1934. Scholar
  29. Huang, L. Y., Wang, Y. C., Liu, C. M., Wu, T. N., Chou, C. H., Sung, F. C., & Wu, C. C. (2011). Water outage increases the risk of gastroenteritis and eyes and skin diseases. BMC Public Health, 11, 726.
  30. Kang, S. H., Oh, I. Y., Heo, J., Lee, H., Kim, J., Lim, W. H., et al. (2016). Heat, heat waves, and out-of-hospital cardiac arrest. International Journal of Cardiology, 221, 232–237. Scholar
  31. Kim, Y., Kim, H., Honda, Y., Guo, Y. L., Chen, B. Y., Woo, J. M., & Ebi, K. L. (2016). Suicide and ambient temperature in East Asian countries: A time-stratified case-crossover analysis. Environmental Health Perspectives, 124(1), 75–80. Scholar
  32. Kim, E., Kim, H., Kim, Y. C., & Lee, J. P. (2018). Association between extreme temperature and kidney disease in South Korea, 2003–2013: Stratified by sex and age groups. Science of the Total Environment, 642, 800–808. Scholar
  33. Kinney, P. L., Schwartz, J., Pascal, M., Petkova, E., Tertre, A. L., Medina, S., & Vautard, R. (2015). Winter season mortality: Will climate warming bring benefits? Environmental Research Letters, 10(6), 064016. Scholar
  34. Lee, S., Lee, H., Myung, W., Kim, E. J., & Kim, H. (2018). Mental disease-related emergency admissions attributable to hot temperatures. Science of the Total Environment, 616–617, 688–694. Scholar
  35. Lee, S., Lee, E., Park, M. S., Kwon, B. Y., Kim, H., Jung, D. H., et al. (2014). Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures. PLoS ONE, 9(4), e94070. Scholar
  36. Lee, J. Y., Park, E. H., Lee, S., Ko, G., Honda, Y., Hashizume, M., et al. (2017). Airborne bacterial communities in three East Asian cities of China, South Korea, and Japan. Scientific Reports, 7(1), 5545. Scholar
  37. Li, Y., Li, C., Luo, S., He, J., Cheng, Y., & Jin, Y. (2017). Impacts of extremely high temperature and heatwave on heatstroke in Chongqing, China. Environmental Science and Pollution Research, 24(9), 8534–8540. Scholar
  38. Li, J., Xu, X., Ding, G., Zhao, Y., Zhao, R., Xue, F., et al. (2016a). A cross-sectional study of heat wave-related knowledge, attitude, and practice among the public in the Licheng District of Jinan City, China. International Journal of Environmental Research and Public Health, 13(7). Scholar
  39. Li, K., Zhao, K., Shi, L., Wen, L., Yang, H., Cheng, J., et al. (2016b). Daily temperature change in relation to the risk of childhood bacillary dysentery among different age groups and sexes in a temperate city in China. Public Health, 131, 20–26. Scholar
  40. Likhvar, V., Honda, Y., & Ono, M. (2011). Relation between temperature and suicide mortality in Japan in the presence of other confounding factors using time-series analysis with a semiparametric approach. Environmental Health and Preventive Medicine, 16(1), 36–43. Scholar
  41. Lim, Y. H., So, R., Lee, C., Hong, Y. C., Park, M., Kim, L., & Yoon, H. J. (2018). Ambient temperature and hospital admissions for acute kidney injury: A time-series analysis. Science of The Total Environment, 616–617, 1134–1138. Scholar
  42. Ma, P., Wang, S., Fan, X., & Li, T. (2016). The impacts of air temperature on accidental casualties in Beijing, China. International Journal of Environmental Research and Public Health, 13(11). Scholar
  43. McGregor, G. R., & Vanos, J. K. (2017). Heat: A primer for public health researchers. Public Health. Scholar
  44. McIver, L., Kim, R., Woodward, A., Hales, S., Spickett, J., Katscherian, D., et al. (2016). Health impacts of climate change in Pacific Island countries: A regional assessment of vulnerabilities and adaptation priorities. Environmental Health Perspectives, 124(11), 1707–1714. Scholar
  45. Miao, Y., Shen, Y. M., Lu, C., Zeng, J., & Deng, Q. (2017). Maternal exposure to ambient air temperature during pregnancy and early childhood pneumonia. Journal of Thermal Biology, 69, 288–293. Scholar
  46. Niu, Y., Chen, R., Liu, C., Ran, P., Chen, A., Chen, X., & Kan, H. (2016). The association between ambient temperature and out-of-hospital cardiac arrest in Guangzhou, China. Science of The Total Environment, 572, 114–118. Scholar
  47. Onozuka, D., & Hagihara, A. (2015). The association of extreme temperatures and the incidence of tuberculosis in Japan. International Journal of Biometeorology, 59(8), 1107–1114. Scholar
  48. Onozuka, D., & Hagihara, A. (2016). Spatial and temporal variation in emergency transport during periods of extreme heat in Japan: A nationwide study. Science of the Total Environment, 544, 220–229. Scholar
  49. Onozuka, D., & Hagihara, A. (2017a). Extreme temperature and out-of-hospital cardiac arrest in Japan: A nationwide, retrospective, observational study. Science of the Total Environment, 575, 258–264. Scholar
  50. Onozuka, D., & Hagihara, A. (2017b). Spatiotemporal variation in heat-related out-of-hospital cardiac arrest during the summer in Japan. Science of the Total Environment, 583, 401–407. Scholar
  51. Onozuka, D., & Hashizume, M. (2011a). Effect of weather variability on the incidence of mumps in children: A time-series analysis. Epidemiology and Infection, 139(11), 1692–1700. Scholar
  52. Onozuka, D., & Hashizume, M. (2011b). The influence of temperature and humidity on the incidence of hand, foot, and mouth disease in Japan. Science of the Total Environment, 410–411, 119–125. Scholar
  53. Onozuka, D., Hashizume, M., & Hagihara, A. (2009). Impact of weather factors on Mycoplasma pneumoniae pneumonia. Thorax, 64(6), 507–511. Scholar
  54. Onozuka, D., Hashizume, M., & Hagihara, A. (2010). Effects of weather variability on infectious gastroenteritis. Epidemiology and Infection, 138(2), 236–243. Scholar
  55. Page, L. A., Hajat, S., & Kovats, R. S. (2007). Relationship between daily suicide counts and temperature in England and Wales. British Journal of Psychiatry, 191, 106–112. Scholar
  56. Phung, D., Chu, C., Rutherford, S., Nguyen, H. L. T., Do, C. M., & Huang, C. (2017). Heatwave and risk of hospitalization: A multi-province study in Vietnam. Environmental Pollution, 220(Pt A), 597–607. Scholar
  57. Phung, D., Chu, C., Tran, D. N., & Huang, C. (2018). Spatial variation of heat-related morbidity: A hierarchical Bayesian analysis in multiple districts of the Mekong Delta Region. Science of the Total Environment, 637–638, 1559–1565. Scholar
  58. Phung, D., Guo, Y., Thai, P., Rutherford, S., Wang, X., Nguyen, M., et al. (2016). The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam. Environmental Pollution, 208(Pt A), 33–39. Scholar
  59. Phung, D., Rutherford, S., Chu, C., Wang, X., Nguyen, M., Nguyen, N. H., et al. (2015). Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam. Occupational and Environmental Medicine, 72(7), 529–535. Scholar
  60. Qiu, H., Sun, S., Tang, R., Chan, K. P., & Tian, L. (2016). Pneumonia hospitalization risk in the elderly attributable to cold and hot temperatures in Hong Kong, China. American Journal of Epidemiology, 184(8), 555–569. Scholar
  61. Sankei Shinbun. (2018, August 1st). Ninety-six heat stroke deaths in July in Tokyo 23 Wards: Four times as high as the last year. Sankei Shinbun. Retrieved from
  62. Seposo, X. T., Dang, T. N., & Honda, Y. (2015). Evaluating the effects of temperature on mortality in Manila City (Philippines) from 2006-2010 using a distributed lag nonlinear model. International Journal of Environmental Research and Public Health, 12(6), 6842–6857. Scholar
  63. Shen, S. Q., Wei, H. X., Fu, Y. H., Zhang, H., Mo, Q. Y., Wang, X. J., et al. (2015). Multiple sources of infection and potential endemic characteristics of the large outbreak of dengue in Guangdong in 2014. Scientific Reports, 5, 16913. Scholar
  64. Sheng, R., Li, C., Wang, Q., Yang, L., Bao, J., Wang, K., et al. (2018). Does hot weather affect work-related injury? A case-crossover study in Guangzhou, China. International Journal of Hygiene and Environmental Health, 221(3), 423–428. Scholar
  65. Song, X., Wang, S., Li, T., Tian, J., Ding, G., Wang, J., et al. (2018). The impact of heat waves and cold spells on respiratory emergency department visits in Beijing, China. Science of the Total Environment, 615, 1499–1505. Scholar
  66. Sun, X., Sun, Q., Yang, M., Zhou, X., Li, X., Yu, A., et al. (2014). Effects of temperature and heat waves on emergency department visits and emergency ambulance dispatches in Pudong New Area, China: A time series analysis. Environmental Health, 13, 76. Scholar
  67. Trang, P. M., Rocklov, J., Giang, K. B., Kullgren, G., & Nilsson, M. (2016). Heatwaves and hospital admissions for mental disorders in Northern Vietnam. PLoS ONE, 11(5), e0155609. Scholar
  68. Wang, Y. C., Lin, Y. K., Chuang, C. Y., Li, M. H., Chou, C. H., Liao, C. H., & Sung, F. C. (2012). Associating emergency room visits with first and prolonged extreme temperature event in Taiwan: A population-based cohort study. Science of The Total Environment, 416, 97–104. Scholar
  69. Wong, H. T., Chiu, M. Y., Wu, C. S., Lee, T. C., & Senior Citizen Home Safety, A. (2015). The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong. International Journal of Biometeorology, 59(3), 373–376. Scholar
  70. Xu, C., Li, Y., Wang, J., & Xiao, G. (2017). Spatial-temporal detection of risk factors for bacillary dysentery in Beijing, Tianjin and Hebei, China. BMC Public Health, 17(1), 743. Scholar
  71. Zhang, W., Du, Z., Zhang, D., Yu, S., & Hao, Y. (2016). Quantifying the adverse effect of excessive heat on children: An elevated risk of hand, foot and mouth disease in hot days. Science of the Total Environment, 541, 194–199. Scholar
  72. Zhang, Y., Yan, C., Kan, H., Cao, J., Peng, L., Xu, J., & Wang, W. (2014). Effect of ambient temperature on emergency department visits in Shanghai, China: A time series study. Environmental Health, 13, 100.
  73. Zhang, Y., Zhao, Q., Zhang, W., Li, S., Chen, G., Han, Z., & Guo, Y. (2017). Are hospital emergency department visits due to dog bites associated with ambient temperature? A time-series study in Beijing, China. Science of The Total Environment, 598, 71–76. Scholar
  74. Zhao, Q., Li, S., Cao, W., Liu, D. L., Qian, Q., Ren, H., et al. (2018). Modeling the present and future incidence of pediatric hand, foot, and mouth disease associated with ambient temperature in Mainland China. Environmental Health Perspectives, 126(4), 047010. Scholar
  75. Zhao, D., Wang, L., Cheng, J., Xu, J., Xu, Z., Xie, M., et al. (2017a). Impact of weather factors on hand, foot and mouth disease, and its role in short-term incidence trend forecast in Huainan City, Anhui Province. International Journal of Biometeorology, 61(3), 453–461. Scholar
  76. Zhao, Q., Zhang, Y., Zhang, W., Li, S., Chen, G., Wu, Y., et al. (2017b). Ambient temperature and emergency department visits: Time-series analysis in 12 Chinese cities. Environmental Pollution, 224, 310–316. Scholar
  77. Zhou, L., Xin, Z., Bai, L., Wan, F., Wang, Y., Sang, S., et al. (2014). Perceptions of heat risk to health: A qualitative study of professional bus drivers and their managers in Jinan, China. International Journal of Environmental Research and Public Health, 11(2), 1520–1535. Scholar
  78. Zhou, X., Zhou, Y., Chen, R., Ma, W., Deng, H., & Kan, H. (2013). High temperature as a risk factor for infectious diarrhea in Shanghai, China. Journal of Epidemiology, 23(6), 418–423.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of TsukubaTsukubaJapan
  2. 2.National Cerebral and Cardiovascular Center Research InstituteSuitaJapan

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