National mortality burden attributable to the unprecedented heatwave in 2022 in China

Jian-Xiong Hu; Yu-Lin Zhuo; Guan-Hao He; Jiang-Mei Liu; Yan-Fang Guo; Tian-Tian Li; Wei-Wei Gong; Fang-Fang Zeng; Hai-Lai Duan; Rui-Lin Meng; Chun-Liang Zhou; Yi-Ze Xiao; Min Yu; Biao Huang; Mai-Geng Zhou; Wen-Jun Ma; Tao Liu

doi:10.1186/s40779-025-00676-2

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National mortality burden attributable to the unprecedented heatwave in 2022 in China

RESEARCH | Updated：2026-08-20

- National mortality burden attributable to the unprecedented heatwave in 2022 in China
- National mortality burden attributable to the unprecedented heatwave in 2022 in China
- Military Medical Research 2026年13卷第6期页码：929-943
- Affiliations：
  
  Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
  Key Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou 510632, China
  Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
  The National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing 100050, China
  Bao’an Chronic Diseases Prevent and Cure Hospital, Shenzhen 518100, Guangdong, China
  Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing 100021, China
  Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310009, China
  Climate Center of Guangdong Province, Guangzhou 510640, China
  Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, China
  Yunnan Provincial Center for Disease Control and Prevention, Kunming 650034, China
  Jilin Provincial Center for Disease Control and Prevention, Changchun 130062, China
  China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
- Author bio：
  
  * Mai-Geng Zhou zhoumaigeng@ncncd.chinacdc.cn
  Wen-Jun Ma mawj@gdiph.org.cn
  Tao Liu gztt_2002@163.com
- Funds：
  
  the National Natural Science Foundation of China(42275187;42375180);the Young Elite Scientists Sponsorship Program by CAST(2022QNRC001);the Talent Support Project of Guangdong Provincial Center for Disease Control and Prevention(2023D001);the Guangdong-Hong Kong-Macao Greater Bay Area Collaborative Research Project on Meteorological Science and Technology(GHMA2024Z05)
- DOI：10.1186/s40779-025-00676-2
  中图分类号：
- 收稿：2025-06-26，
  
  录用：2025-11-20，
  
  网络首发：2025-12-15，
  
  纸质出版：2026-06
- Accepted：
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Jian-Xiong Hu, Yu-Lin Zhuo, Guan-Hao He, 等. National mortality burden attributable to the unprecedented heatwave in 2022 in China[J]. Military Medical Research, 2026,13(6):929-943.

Jian-Xiong Hu, Yu-Lin Zhuo, Guan-Hao He, et al. National mortality burden attributable to the unprecedented heatwave in 2022 in China[J]. Military Medical Research, 2026, 13(6): 929-943.
Jian-Xiong Hu, Yu-Lin Zhuo, Guan-Hao He, 等. National mortality burden attributable to the unprecedented heatwave in 2022 in China[J]. Military Medical Research, 2026,13(6):929-943. DOI： 10.1186/s40779-025-00676-2.

Jian-Xiong Hu, Yu-Lin Zhuo, Guan-Hao He, et al. National mortality burden attributable to the unprecedented heatwave in 2022 in China[J]. Military Medical Research, 2026, 13(6): 929-943. DOI： 10.1186/s40779-025-00676-2.

摘要

Abstract

Background

In 2022

China experienced an unprecedented heatwave event

raising concerns about the health impacts of heatwaves. This study aims to understand the devastating health risk of the exceptional heatwave in 2022 by comparing heatwave-related mortality burden in 2022 with that during 2000–2021.

Methods

We collected daily mortality and daily maximum temperature (DMT) during 2006–2017 in 364 locations(counties/districts) of China. Heatwave was defined as an event with 2 or more consecutive days of DMT exceeding the 92.5th percentile. We employed a distributed lag nonlinear model (DLNM) and a meta-analysis to examine the heatwave-mortality association based on the data from 364 counties/districts

and then this association was used to assess the mortality burden attributable to heatwaves during 2000–2022 in 368 cities in China. A percentage change (%) indicator

comparing the 2022 mortality burden to the average value from 2000 to 2021

was further calculated to highlight the severity of heatwaves in 2022.

Results

In the past 2 decades

the frequency and intensity of heatwaves in China significantly increased

with the cumulative excessive degree-day increasing to 31

626 in 2022 compared with the annual average value of 13

772 during 2000–2021 across China. In 2022

we observed 62

961 [95% confidence internal (CI) 54

945–70

413]heatwave-related deaths in China

which was much higher than the annual average [35

987 (95% CI 31

252–40

471)]attributable to heatwaves during 2000–2021. The vulnerability groups of heatwave-related mortality in 2022 primarily included patients with cardiovascular diseases [40

567 (95% CI 35

313–45

404)]

females [35

876 (95% CI 31

035–41

005)]

and people aged over 65 years [56

208 (95% CI 49

023–62

864)]; and greater heatwave-related mortality was found in eastern-central China. The attributable fraction (AF) of heatwave-related deaths increased from an annual average of 11.01‰ (95% CI 9.56–12.38) during 2000–2021 to 18.11‰ (95% CI 15.80–20.25) in 2022 with 64.43% increment (95% CI 38.10–93.78)

and the increase rates were greater in Xizang Autonomous Region(159.77%

95% CI 12.84–477.87) and Sichuan Province (133.64%

95% CI 3.84–416.61).

Conclusions

This study indicated that the frequency and intensity of heatwaves significantly increased in the past 2 decades in China

and the 2022 heatwaves were linked to a substantial mortality burden in China

with significant population and regional heterogeneity. Our findings underscore the need for developing comprehensive heat adaptation plans in the context of rapid aging and ongoing global warming.

关键词

Keywords

references

Perkins-Kirkpatrick SE , Gibson PB . Changes in regional heatwave characteristics as a function of increasing global temperature . Sci Rep . 2017 ; 7 ( 1 ): 12256 .

Masson-Delmotte V , Zhai P , Pirani A , Connors L , Pean C , Berger S , et al . Contribution of working group I to the sixth assessment report of the intergovernmental panel on climate change . In: climate change 2021:the physical science basis . 2021 . https://www.ipcc.ch/report/ar6/wg1 . Accessed 15 Jan 2025 .

Poumadère M , Mays C , Le Mer S , Blong R . The 2003 heat wave in France: dangerous climate change here and now . Risk Anal . 2005 ; 25 ( 6 ): 1483 – 94 .

Azhar GS , Mavalankar D , Nori-Sarma A , Rajiva A , Dutta P , Jaiswal A , et al . Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave . PLoS ONE . 2014 ; 9 ( 3 ): e91831 .

Perkins-Kirkpatrick SE , White CJ , Alexander LV , Argüeso D , Boschat G , Cowan T , et al . Natural hazards in Australia: heatwaves . Clim Change . 2016 ; 139 : 101 – 14 .

Fouillet A , Rey G , Laurent F , Pavillon G , Bellec S , Guihenneuc-Jouyaux C , et al . Excess mortality related to the August 2003 heat wave in France . Int Arch Occup Environ Health . 2006 ; 80 ( 1 ): 16 – 24 .

The Copernicus Climate Change Service . Summer 2022 Europe’s hottest on record . 2022 . https://climate.copernicus.eu/copernicus-summer-2022-europes-hottest-record . Accessed 20 June 2023 .

Xu W , Yuan W , Wu D , Zhang Y , Shen R , Xia X , et al . Impacts of record-breaking compound heatwave and drought events in 2022 China on vegetation growth . Agric For Meteorol . 2024 ; 344 : 109799 .

National Climate Center of the China Meteorological Administration . China Climate Bulletin (2022) . 2023 . https://www.cma.gov.cn/zfxxgk/gknr/qxbg/202303/t20230324_5396394.html . Accessed 12 May 2024 .

Yuan Y , Liao Z , Zhou B , Zhai P . Unprecedented hot extremes observed in city clusters in China during summer 2022 . J Meteorol Res . 2023 ; 37 ( 2 ): 141 – 8 .

Zhu Q , Ye P , Wang Y , Duan L , He G , Er Y , et al . Heatwaves increase road traffic injury morbidity risk and burden in China and its provinces . Environ Int . 2024 ; 188 : 108760 .

Xu Z , FitzGerald G , Guo Y , Jalaludin B , Tong S . Impact of heatwave on mortality under different heatwave definitions: a systematic review and meta-analysis . Environ Int . 2016 ; 89–90 : 193 – 203 .

Damtew YT , Tong M , Varghese BM , Anikeeva O , Hansen A , Dear K , et al . Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis . EBioMedicine . 2023 ; 91 : 104582 .

Gasparrini A , Armstrong B . The impact of heat waves on mortality . Epidemiology . 2011 ; 22 ( 1 ): 68 – 73 .

Gronlund CJ , Zanobetti A , Schwartz JD , Wellenius GA , O’Neill MS . Heat,heat waves, and hospital admissions among the elderly in the United States, 1992–2006 . Environ Health Perspect . 2014 ; 122 ( 11 ): 1187 – 92 .

Liu J , Qi J , Yin P , Liu W , He C , Gao Y , et al . Rising cause-specific mortality risk and burden of compound heatwaves amid climate change . Nat Clim Change . 2024 ; 14 : 1201 – 9 .

Guo Y , Gasparrini A , Armstrong BG , Tawatsupa B , Tobias A , Lavigne E , et al . Heat wave and mortality: a multicountry, multicommunity study . Environ Health Perspect . 2017 ; 125 ( 8 ): 087006 .

Bobb JF , Obermeyer Z , Wang Y , Dominici F . Cause-specific risk of hospital admission related to extreme heat in older adults . JAMA . 2014 ; 312 ( 24 ): 2659 – 67 .

Xi D , Liu L , Zhang M , Huang C , Burkart KG , Ebi K , et al . Risk factors associated with heatwave mortality in Chinese adults over 65 years . Nat Med . 2024 ; 30 ( 5 ): 1489 – 98 .

Achebak H , Devolder D , Ballester J . Trends in temperature-related agespecific and sex-specific mortality from cardiovascular diseases in Spain: a national time-series analysis . Lancet Planet Health . 2019 ; 3 ( 7 ): e297 – 306 .

Singh N , Areal AT , Breitner S , Zhang S , Agewall S , Schikowski T , et al . Heat and cardiovascular mortality: an epidemiological perspective . Circ Res . 2024 ; 134 ( 9 ): 1098 – 112 .

Yan M , Xie Y , Zhu H , Ban J , Gong J , Li T . Cardiovascular mortality risks during the 2017 exceptional heatwaves in China . Environ Int . 2023 ; 172 : 107767 .

Cheng B , Li H , Meng K , Li T , Meng X , Wang J , et al . Short-term effects of heatwaves on clinical and subclinical cardiovascular indicators in Chinese adults: a distributed lag analysis . Environ Int . 2024 ; 183 : 108358 .

Whitman S , Good G , Donoghue ER , Benbow N , Shou W , Mou S . Mortality in Chicago attributed to the July 1995 heat wave . Am J Public Health . 1997 ; 87 ( 9 ): 1515 – 8 .

Robine JM , Cheung SLK , Roy SL , Oyen HV , Griffiths C , Michel JP , et al . Death toll exceeded 70,000 in Europe during the summer of 2003 . C R Biol . 2008 ; 331 ( 2 ): 171 – 8 .

Yao Y , Zhang W , Kirtman B . Increasing impacts of summer extreme precipitation and heatwaves in Eastern China . Clim Change . 2023 ; 176 : 131 .

Ballester J , Quijal-Zamorano M , Méndez Turrubiates RF , Pegenaute F , Herrmann FR , Robine JM , et al . Heat-related mortality in Europe during the summer of 2022 . Nat Med . 2023 ; 29 : 1857 – 66 .

Huber V , Breitner-Busch S , He C , Matthies-Wiesler F , Peters A , Schneider A . Heat-related mortality in the extreme summer of 2022: an analysis based on daily data . Dtsch Arztebl Int . 2024 ; 121 ( 3 ): 79 – 85 .

Lu R , Xu K , Chen R , Chen W , Li F , Lv C . Heat waves in summer 2022 and increasing concern regarding heat waves in general . Atmos Ocean Sci Lett . 2023 ; 16 ( 1 ): 100290 .

Wang L , Sun L , Li W , Chen X , Li Y , Zou X , et al . State of China’s climate in 2022 . Atmos Ocean Sci Lett . 2023 ; 16 ( 6 ): 100356 .

Chen H , Zhao L , Dong W , Cheng L , Cai W , Yang J , et al . Spatiotemporal variation of mortality burden attributable to heatwaves in China, 1979-2020 . Sci Bull . 2022 ; 67 ( 13 ): 1340 – 4 .

Huang Y , Song H , Cheng Y , Bi P , Li Y , Yao X . Heatwave and urinary hospital admissions in China: disease burden and associated economic loss, 2014 to 2019 . Sci Total Environ . 2023 ; 857 ( Pt 2 ): 159565 .

Liu S , Wu X , Lopez AD , Wang L , Cai Y , Page A , et al . An integrated national mortality surveillance system for death registration and mortality surveillance, China . Bull World Health Organ . 2016 ; 94 ( 1 ): 46 – 57 .

Liu T , Zhou C , Zhang H , Huang B , Xu Y , Lin L , et al . Ambient temperature and years of life lost: a national study in China . Innovation . 2020 ; 2 ( 1 ): 100072 .

Hu J , Hou Z , Xu Y , Zhou M , Zhou C , Xiao Y , et al . Life loss of cardiovascular diseases per death attributable to ambient temperature: a national time series analysis based on 364 locations in China . Sci Total Environ . 2021 ; 756 : 142614 .

World Health Organization . International statistical classification of diseases and related health problems 10th revision . https://icd.who.int/browse10/2019/en . Accessed 24 Oct 2025 .

Zhao Q , Li S , Ye T , Wu Y , Gasparrini A , Tong S , et al . Global, regional, and national burden of heatwave-related mortality from 1990 to 2019: a three-stage modelling study . PLoS Med . 2024 ; 21 ( 5 ): e1004364 .

Wei J , Li Z , Lyapustin A , Sun L , Peng Y , Xue W , et al . Reconstructing 1-km-resolution high-quality PM 2.5 data records from 2000 to 2018 in China:spatiotemporal variations and policy implications . Remote Sens Environ . 2021 ; 252 : 112136 .

Wei J , Li Z , Li K , Dickerson RR , Pinker RT , Wang J , et al . Full-coverage mapping and spatiotemporal variations of ground-level ozone (O 3 ) pollution from 2013 to 2020 across China . Remote Sens Environ . 2022 ; 270 : 112775 .

Ma J , Sun Y , Meng D , Huang S , Li N , Zhu H . Accuracy assessment of two global gridded population dataset: a case study in China . Proceedings of the 4th International Conference on Information Science and Systems . 2021 ; 120 - 5 .

Yang J , Yin P , Sun J , Wang B , Zhou M , Li M , et al . Heatwave and mortality in 31 major Chinese cities: definition, vulnerability and implications . Sci Total Environ . 2019 ; 649 : 695 – 702 .

Fouillet A , Rey G , Jougla E , Frayssinet P , Bessemoulin P , Hémon D . A predictive model relating daily fluctuations in summer temperatures and mortality rates . BMC Public Health . 2007 ; 7 : 114 .

Romanello M , McGushin A , Di Napoli C , Drummond P , Hughes N , Jamart L , et al . The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future . Lancet . 2021 ; 398 ( 10311 ): 1619 – 62 .

Gasparrini A , Armstrong B , Kenward MG . Distributed lag non‐linear models . Stat Med . 2010 ; 29 ( 21 ): 2224 – 34 .

Gasparrini A . Distributed lag linear and non-linear models in R: the package dlnm . J Stat Softw . 2011 ; 43 ( 8 ): 1 – 20 .

Chen H , Zhao L , Cheng L , Zhang Y , Wang H , Gu K , et al . Projections of heatwave-attributable mortality under climate change and future population scenarios in China . Lancet Reg Health . 2022 ; 28 : 100582 .

Guo Y , Gasparrini A , Li S , Sera F , Vicedo-Cabrera A , Coelho M , et al . Quantifying excess deaths related to heatwaves under climate change scenarios: a multicountry time series modelling study . PLoS Med . 2018 ; 15 ( 7 ): e1002629 .

Hu J , Huang S , Zhuo Y , Zhang J , Gong W , He G , et al . The mechanism-specific injury mortality burden associated with heatwave in China in a warming world . Environ Int . 2025 ; 195 : 109241 .

Onambele L , Guillen-Aguinaga S , Guillen-Aguinaga L , Ortega-Leon W , Montejo R , Alas-Brun R , et al . Trends, projections, and regional disparities of maternal mortality in Africa (1990–2030): an ARIMA forecasting approach . Epidemiologia . 2023 ; 4 ( 3 ): 322 – 51 .

Anderson GB , Bell ML , Peng RD . Methods to calculate the heat index as an exposure metric in environmental health research . Environ Health Perspect . 2013 ; 121 ( 10 ): 1111 – 9 .

Zhou Y , Gu S , Yang H , Ge Z , Dong G , Zhao Y , et al . Escalating heatwave exposure of the elderly across China . Environ Res . 2025 ; 282 : 121986 .

Xu Y , Wu X , Kumar R , Barth M , Diao C , Gao M , et al . Substantial increase in the joint occurrence and human exposure of heatwave and high-PM hazards over south Asia in the mid-21st century . AGU Adv . 2020 ; 1 ( 2 ): e2019AV000103 .

Zhou Y , Larochelle L , Khan FA , Pilote L . Sex differences in the impact of extreme heat on cardiovascular disease outcomes: a systematic review and meta-analysis . Environ Health . 2025 ; 24 ( 1 ): 20 .

van Steen Y , Ntarladima AM , Grobbee R , Karssenberg D , Vaartjes I . Sex differences in mortality after heat waves: are elderly women at higher risk? . Int Arch Occup Environ Health . 2019 ; 92 ( 1 ): 37 – 48 .

Yin P , Chen R , Wang L , Liu C , Niu Y , Wang W , et al . The added effects of heatwaves on cause-specific mortality: a nationwide analysis in 272 Chinese cities . Environ Int . 2018 ; 121 ( Pt 1 ): 898 – 905 .

Stafoggia M , Forastiere F , Agostini D , Biggeri A , Bisanti L , Cadum E , et al . Vulnerability to heat-related mortality: a multicity, population-based, case-crossover analysis . Epidemiology . 2006 ; 17 ( 3 ): 315 – 23 .

Margolis HG . Heat waves and rising temperatures: human health impacts and the determinants of vulnerability . In: Pinkerton KE , Rom WN , editors. Climate change and global public health . Totowa : Humana Press ; 2020 . p. 123 – 61 .

Cramer MN , Gagnon D , Laitano O , Crandall CG . Human temperature regulation under heat stress in health, disease, and injury . Physiol Rev . 2022 ; 102 ( 4 ): 1907 – 89 .

Kim YO , Lee W , Kim H , Cho Y . Social isolation and vulnerability to heatwave-related mortality in the urban elderly population: a time-series multi-community study in Korea . Environ Int . 2020 ; 142 : 105868 .

Song X , Wang S , Hu Y , Yue M , Zhang T , Liu Y , et al . Impact of ambient temperature on morbidity and mortality: an overview of reviews . Sci Total Environ . 2017 ; 586 : 241 – 54 .

Donaldson GC , Keatinge WR , Saunders RD . Cardiovascular responses to heat stress and their adverse consequences in healthy and vulnerable human populations . Int J Hyperthermia . 2003 ; 19 ( 3 ): 225 – 35 .

Nixdorf-Miller A , Hunsaker DM , 3rd Hunsaker JC . Hypothermia and hyperthermia medicolegal investigation of morbidity and mortality from exposure to environmental temperature extremes . Arch Pathol Lab Med . 2006 ; 130 ( 9 ): 1297 – 304 .

Ma W , Zeng W , Zhou M , Wang L , Rutherford S , Lin H , et al . The short-term effect of heat waves on mortality and its modifiers in China: an analysis from 66 communities . Environ Int . 2015 ; 75 : 103 – 9 .

Ishigami A , Hajat S , Kovats RS , Bisanti L , Rognoni M , Russo A , et al . An ecological time-series study of heat-related mortality in three European cities . Environ Health . 2008 ; 7 : 5 .

Office of the Leading Group of the State Council for the Seventh National Population Census . China Population Census Yearbook 2020 . Beijing : China Statistics Press ; 2022 .

Luo Y , Su B , Zheng X . Trends and challenges for population and health during population aging - China, 2015–2050 . China CDC Wkly . 2021 ; 3 ( 28 ): 593 – 8 .

Lewandowski SA , Kioumourtzoglou MA , Shaman JL . Heat stress illness outcomes and annual indices of outdoor heat at U.S . Army installations. PLoS ONE . 2022 ; 17 ( 11 ): e0263803 .

Qiao Z , Wang N , Chen J , Xu X , Liu L , Han D . Understanding the differences in the contribution and impact of urbanization on urban warming during heatwave and non-heatwave periods in China . J Clean Prod . 2024 ; 474 : 143626 .

United Nations . Press Conference by Secretary-General António Guterres at United Nations Headquarters . https://press.un.org/en/2023/sgsm21893.doc.htm . Accessed 24 Oct 2025 .

Wang F , Harindintwali J , Wei K , Shan Y , Mi Z , Costello MJ , et al . Climate change: strategies for mitigation and adaptation . Innov Geosci . 2023 ; 1 ( 1 ): 100015 .

Li T . A public health initiative for action on early warning of heat health risks . China CDC Wkly . 2023 ; 5 ( 29 ): 639 – 41 .

Volenzo TE , Odiyo JO . Linking risk communication and sustainable climate change action: a conceptual framework . Jamba . 2019 ; 11 ( 1 ): 703 .

Cui Y , Yin M , Cheng X , Tang J , He B . Towards cool cities and communities:preparing for an increasingly hot future by the development of heat-resilient infrastructure and urban heat management plan . Environ Technol Innov . 2024 ; 34 : 103568 .

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