BACKGROUND: The regional disparity of heatwave-related mortality over a long period has not been sufficiently assessed across the globe, impeding the localisation of adaptation planning and risk management towards climate change. We quantified the global mortality burden associated with heatwaves at a spatial resolution of 0.5°×0.5° and the temporal change from 1990 to 2019. METHODS AND FINDINGS: We collected data on daily deaths and temperature from 750 locations of 43 countries or regions, and 5 meta-predictors in 0.5°×0.5° resolution across the world. Heatwaves were defined as location-specific daily mean temperature ≥95th percentiles of year-round temperature range with duration ≥2 days. We first estimated the location-specific heatwave-mortality association. Secondly, a multivariate meta-regression was fitted between location-specific associations and 5 meta-predictors, which was in the third stage used with grid cell-specific meta-predictors to predict grid cell-specific association. Heatwave-related excess deaths were calculated for each grid and aggregated. During 1990 to 2019, 0.94% (95% CI: 0.68-1.19) of deaths [i.e., 153,078 cases (95% eCI: 109,950-194,227)] per warm season were estimated to be from heatwaves, accounting for 236 (95% eCI: 170-300) deaths per 10 million residents. The ratio between heatwave-related excess deaths and all premature deaths per warm season remained relatively unchanged over the 30 years, while the number of heatwave-related excess deaths per 10 million residents per warm season declined by 7.2% per decade in comparison to the 30-year average. Locations with the highest heatwave-related death ratio and rate were in Southern and Eastern Europe or areas had polar and alpine climates, and/or their residents had high incomes. The temporal change of heatwave-related mortality burden showed geographic disparities, such that locations with tropical climate or low incomes were observed with the greatest decline. The main limitation of this study was the lack of data from certain regions, e.g., Arabian Peninsula and South Asia. CONCLUSIONS: Heatwaves were associated with substantial mortality burden that varied spatiotemporally over the globe in the past 30 years. The findings indicate the potential benefit of governmental actions to enhance health sector adaptation and resilience, accounting for inequalities across communities.

Center for Environmental and Respiratory Health Research University of Oulu Oulu Finland

Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne Australia

Climate Research Foundation Madrid Spain

Department of Environmental Health Harvard T H Chan School of Public Health Boston Massachusetts United States of America

Department of Environmental Health School of Public Health Fudan University Shanghai China

Department of Epidemiology Lazio Regional Health Service Asl Roma 1 Rome Italy

Department of Epidemiology School of Public Health Qilu hospital Cheeloo College of Medicine Shandong University Jinan China

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London United Kingdom

Department of Public Health University of Helsinki Helsinki Finland

Department of Statistics Computer Science and Applications G Parenti University of Florence Florence Italy

Environment and Health Modelling Lab Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London United Kingdom

Environmental Health Science and Research Bureau Health Canada Ottawa Canada

Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

INSPER São Paulo Brazil

Institute of Atmospheric Physics Academy of Sciences of the Czech Republic Prague Czech Republic

Institute of Environmental Assessment and Water Research Barcelona Spain

Institute of Social and Preventive Medicine University of Bern Bern Switzerland

Korea University Seoul South Korea

Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland

National Institute of Environmental Health Chinese Center for Disease Control and Prevention Beijing China

Oeschger Center for Climate Change Research University of Bern Bern Switzerland

Santé Publique France Department of Environmental and Occupational Health French National Public Health Agency Saint Maurice France

School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa Canada

School of Public Health and Social Work Queensland University of Technology Brisbane Australia

School of the Environment Yale University New Haven Connecticut United States of America

Spanish Consortium for Research and Public Health Madrid Spain

Technological University Dublin Ireland

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