Economic burden of premature deaths attributable to different heatwaves in China: A multi-site study, 2014-2019

It has been well documented that heatwaves are linked to elevated mortality and morbidity. However, the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality, which can provide important insights for public health considerations. Hence, we used a two-stage time series analysis, combined with values of statistical life (V-SL) based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions. We further conducted stratified analyses by age, sex, and region. We found 2.9% (95%CI: 0.0%, 6.5%)-20.0% (95%CI: 2.9%, 34.2%) of V-SL were attributable to heatwaves, corresponding to attributable economic losses (AELs) of 2.20 (95%CI: 0.32, 3.77)-4.77 (95%CI: 1.53, 7.63) billion CNY. The economic burden of death was most sensitive to heatwave H99P_2D (99th percentile, at last 2 consecutive days), while H975P_2D (97.5th percentile, at last 2 consecutive days) caused the highest attributable economic losses. Females and elderly people aged >= 65 years were more sensitive. The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves, respectively. By contrast, the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves, respectively. The AELs were larger in urban areas than in rural areas. Tailored intervention strategies, primarily focusing on vulnerable populations and regions, should be formulated to reduce the economic loss due to heatwaves in the context of climate change.