The effects of summer temperature and heat waves on heat-related illness in a coastal city of China, 2011-2013

Background: Devastating health effects from recent heat waves in China have highlighted the importance of understanding health consequences from extreme heat stress. Despite the increasing mortality from extreme heat, very limited studies have quantified the effects of summer extreme temperature on heat-related illnesses in China. Methods: The associations between extreme heat and daily heat-related illnesses that occurred in the summers of 2011-2013 in Ningbo, China, have been examined, using a distributed lag non-linear model (DLNM) based on 3862 cases. The excess morbidities of heat-related illness during each heat wave have been calculated separately and the cumulative heat wave effects on age-, sex-, and cause-specific illnesses in each year along lags have been estimated as well. Results: After controlling the effect of relative humidity, it is found that maximum temperature, rather than heat index, was a better predictor of heat-related illnesses in summers. A positive association between maximum temperatures and occurrence of heat-related diseases was apparent, especially at short lag effects. Six heat waves, during the period of 2011-2013 were identified and all associated with excess heat-related illnesses. Relative to the average values for the corresponding periods in 2011 and 2012, a total estimated 679 extra heat-related illnesses occurred during three heat waves in 2013. The significant prolonged heat wave effects on total heat-related illnesses during heat waves in three study years have also been identified. The strongest cumulative effect of heat waves was on severe heat diseases in 2013, with a 10-fold increased risk. More males than females, individuals with more severe forms of illness, were more affected by the heat. However, all age groups were vulnerable. Conclusions: Recent heat waves had a substantial and delayed effect on heat illnesses in Ningbo. Relevant active well-organized public health initiatives should be implemented to reduce the adverse effects of heat extremes on the illnesses. (C) 2014 The Authors. Published by Elsevier Inc.