Rainfall events and daily mortality across 645 global locations: two stage time series analysis

Cheng He; Susanne Breitner-Busch; Veronika Huber; Kai Chen; Siqi Zhang; Antonio Gasparrini; Michelle Bell; Haidong Kan; Dominic Royé; Ben Armstrong; Joel Schwartz; Francesco Sera; Ana Maria Vicedo-Cabrera; Yasushi Honda; Jouni J.K. Jaakkola; Niilo Ryti; Jan Kyselý; Yuming Guo; Shilu Tong; Francesca de’Donato; Paola Michelozzi; Micheline de Sousa Zanotti Stagliorio Coelho; Paulo Hilario Nascimento Saldiva; Eric Lavigne; Hans Orru; Ene Indermitte; Mathilde Pascal; Patrick Goodman; Ariana Zeka; Yoonhee Kim; Magali Hurtado Diaz; Eunice Elizabeth Félix Arellano; Ala Overcenco; Jochem Klompmaker; Shilpa Rao; Alfonso Diz Lois Palomares; Gabriel Carrasco; Xerxes Seposo; Susana das Neves Pereira da Silva; Joana Madureira; Iulian Horia Holobaca; Noah Scovronick; Fiorella Acquaotta; Ho Kim; Whanhee Lee; Masahiro Hashizume; Aurelio Tobias; Carmen Íñiguez; Bertil Forsberg; Martina S. Ragettli; Yue Leon Guo; Shih Chun Pan; Samuel Osorio; Shanshan Li; Antonella Zanobetti; Tran Ngoc Dang; Do Van Dung; Alexandra Schneider

doi:10.1136/bmj-2024-080944

Rainfall events and daily mortality across 645 global locations: two stage time series analysis

Cheng He
, Susanne Breitner-Busch
, Veronika Huber
, Kai Chen
, Siqi Zhang
, Antonio Gasparrini
, Michelle Bell
, Haidong Kan
, Dominic Royé
, Ben Armstrong
, Joel Schwartz
, Francesco Sera
, Ana Maria Vicedo-Cabrera
, Yasushi Honda
, Jouni J.K. Jaakkola
, Niilo Ryti
, Jan Kyselý
, Yuming Guo
, Shilu Tong
, Francesca de’Donato

Paola Michelozzi, Micheline de Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Eric Lavigne, Hans Orru, Ene Indermitte, Mathilde Pascal, Patrick Goodman, Ariana Zeka, Yoonhee Kim, Magali Hurtado Diaz, Eunice Elizabeth Félix Arellano, Ala Overcenco, Jochem Klompmaker, Shilpa Rao, Alfonso Diz Lois Palomares, Gabriel Carrasco, Xerxes Seposo, Susana das Neves Pereira da Silva, Joana Madureira, Iulian Horia Holobaca, Noah Scovronick, Fiorella Acquaotta, Ho Kim, Whanhee Lee, Masahiro Hashizume, Aurelio Tobias, Carmen Íñiguez, Bertil Forsberg, Martina S. Ragettli, Yue Leon Guo, Shih Chun Pan, Samuel Osorio, Shanshan Li, Antonella Zanobetti, Tran Ngoc Dang, Do Van Dung, Alexandra Schneider

School of Public Health and Administration

German Research Center for Environmental Health
Ludwig-Maximilians-Universität München
Yale University
London School of Hygiene and Tropical Medicine
Yale University
Korea University
Fudan University
Centro de Investigación Biomédica en Red de Epidemiología y Salud Publica
Harvard T.H. Chan School of Public Health
University of Florence
Institute of Social and Preventive Medicine
Universität Bern
National Institute for Environmental Studies of Japan
University of Oulu
Finnish Meteorological Institute
Institute of Atmospheric Physics of the Academy of Sciences of the Czech Republic
Czech University of Life Sciences Prague
Monash University
Chinese Center for Disease Control and Prevention
Queensland University of Technology
Department of Epidemiology Lazio Regional Health Service
University of São Paulo
INSPER
University of Ottawa
Health Canada
University of Tartu
French National Public Health Agency
Technological University Dublin
University College London
Graduate School of Medicine
National Institute of Public Health
National Agency for Public Health of the Ministry of Health
Centre for Sustainability and Environmental Health
Norwegian Institute of Public Health
Department of Medicine
Nagasaki University
National Institute of Health Dr. Ricardo Jorge
University of Porto
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)
Babes Bolyai University
Rollins School of Public Health
University of Torino
Seoul National University
Pusan National University
Spanish Council for Scientific Research
University of Valencia
Umeå University
Swiss Tropical and Public Health Institute Swiss TPH
University of Basel
National Taiwan University Hospital
National Taiwan University
National Health Research Institutes Taiwan
Duy Tan University
University of Medicine and Pharmacy at Ho Chi Minh City

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

OBJECTIVE To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN Two stage time series analysis. SETTING 645 locations across 34 countries or regions. POPULATION Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS During the study period, a total of 50913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk <1) with moderate-heavy rainfall events, shifting to adverse effects (relative risk >1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure.

Original language	English
Article number	e080944
Journal	BMJ
Volume	387
DOIs	https://doi.org/10.1136/bmj-2024-080944
State	Published - 2024

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 9 Industry, Innovation, and Infrastructure
SDG 11 Sustainable Cities and Communities

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10.1136/bmj-2024-080944

Cite this

He, C., Breitner-Busch, S., Huber, V., Chen, K., Zhang, S., Gasparrini, A., Bell, M., Kan, H., Royé, D., Armstrong, B., Schwartz, J., Sera, F., Vicedo-Cabrera, A. M., Honda, Y., Jaakkola, J. J. K., Ryti, N., Kyselý, J., Guo, Y., Tong, S., ... Schneider, A. (2024). Rainfall events and daily mortality across 645 global locations: two stage time series analysis. BMJ, 387, Article e080944. https://doi.org/10.1136/bmj-2024-080944

@article{08259613185f44e29ed47f178d76f62b,

title = "Rainfall events and daily mortality across 645 global locations: two stage time series analysis",

abstract = "OBJECTIVE To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN Two stage time series analysis. SETTING 645 locations across 34 countries or regions. POPULATION Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS During the study period, a total of 50913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95\% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk <1) with moderate-heavy rainfall events, shifting to adverse effects (relative risk >1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure.",

author = "Cheng He and Susanne Breitner-Busch and Veronika Huber and Kai Chen and Siqi Zhang and Antonio Gasparrini and Michelle Bell and Haidong Kan and Dominic Roy{\'e} and Ben Armstrong and Joel Schwartz and Francesco Sera and Vicedo-Cabrera, \{Ana Maria\} and Yasushi Honda and Jaakkola, \{Jouni J.K.\} and Niilo Ryti and Jan Kysel{\'y} and Yuming Guo and Shilu Tong and Francesca de{\textquoteright}Donato and Paola Michelozzi and \{de Sousa Zanotti Stagliorio Coelho\}, Micheline and Saldiva, \{Paulo Hilario Nascimento\} and Eric Lavigne and Hans Orru and Ene Indermitte and Mathilde Pascal and Patrick Goodman and Ariana Zeka and Yoonhee Kim and Diaz, \{Magali Hurtado\} and Arellano, \{Eunice Elizabeth F{\'e}lix\} and Ala Overcenco and Jochem Klompmaker and Shilpa Rao and Palomares, \{Alfonso Diz Lois\} and Gabriel Carrasco and Xerxes Seposo and \{Pereira da Silva\}, \{Susana das Neves\} and Joana Madureira and Holobaca, \{Iulian Horia\} and Noah Scovronick and Fiorella Acquaotta and Ho Kim and Whanhee Lee and Masahiro Hashizume and Aurelio Tobias and Carmen {\'I}{\~n}iguez and Bertil Forsberg and Ragettli, \{Martina S.\} and Guo, \{Yue Leon\} and Pan, \{Shih Chun\} and Samuel Osorio and Shanshan Li and Antonella Zanobetti and Dang, \{Tran Ngoc\} and \{Van Dung\}, Do and Alexandra Schneider",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019.",

year = "2024",

doi = "10.1136/bmj-2024-080944",

language = "Ingl{\'e}s",

volume = "387",

journal = "BMJ",

issn = "0959-8146",

}

He, C, Breitner-Busch, S, Huber, V, Chen, K, Zhang, S, Gasparrini, A, Bell, M, Kan, H, Royé, D, Armstrong, B, Schwartz, J, Sera, F, Vicedo-Cabrera, AM, Honda, Y, Jaakkola, JJK, Ryti, N, Kyselý, J, Guo, Y, Tong, S, de’Donato, F, Michelozzi, P, de Sousa Zanotti Stagliorio Coelho, M, Saldiva, PHN, Lavigne, E, Orru, H, Indermitte, E, Pascal, M, Goodman, P, Zeka, A, Kim, Y, Diaz, MH, Arellano, EEF, Overcenco, A, Klompmaker, J, Rao, S, Palomares, ADL, Carrasco, G, Seposo, X, Pereira da Silva, SDN, Madureira, J, Holobaca, IH, Scovronick, N, Acquaotta, F, Kim, H, Lee, W, Hashizume, M, Tobias, A, Íñiguez, C, Forsberg, B, Ragettli, MS, Guo, YL, Pan, SC, Osorio, S, Li, S, Zanobetti, A, Dang, TN, Van Dung, D & Schneider, A 2024, 'Rainfall events and daily mortality across 645 global locations: two stage time series analysis', BMJ, vol. 387, e080944. https://doi.org/10.1136/bmj-2024-080944

TY - JOUR

T1 - Rainfall events and daily mortality across 645 global locations

T2 - two stage time series analysis

AU - He, Cheng

AU - Breitner-Busch, Susanne

AU - Huber, Veronika

AU - Chen, Kai

AU - Zhang, Siqi

AU - Gasparrini, Antonio

AU - Bell, Michelle

AU - Kan, Haidong

AU - Royé, Dominic

AU - Armstrong, Ben

AU - Schwartz, Joel

AU - Sera, Francesco

AU - Vicedo-Cabrera, Ana Maria

AU - Honda, Yasushi

AU - Jaakkola, Jouni J.K.

AU - Ryti, Niilo

AU - Kyselý, Jan

AU - Guo, Yuming

AU - Tong, Shilu

AU - de’Donato, Francesca

AU - Michelozzi, Paola

AU - de Sousa Zanotti Stagliorio Coelho, Micheline

AU - Saldiva, Paulo Hilario Nascimento

AU - Lavigne, Eric

AU - Orru, Hans

AU - Indermitte, Ene

AU - Pascal, Mathilde

AU - Goodman, Patrick

AU - Zeka, Ariana

AU - Kim, Yoonhee

AU - Diaz, Magali Hurtado

AU - Arellano, Eunice Elizabeth Félix

AU - Overcenco, Ala

AU - Klompmaker, Jochem

AU - Rao, Shilpa

AU - Palomares, Alfonso Diz Lois

AU - Carrasco, Gabriel

AU - Seposo, Xerxes

AU - Pereira da Silva, Susana das Neves

AU - Madureira, Joana

AU - Holobaca, Iulian Horia

AU - Scovronick, Noah

AU - Acquaotta, Fiorella

AU - Kim, Ho

AU - Lee, Whanhee

AU - Hashizume, Masahiro

AU - Tobias, Aurelio

AU - Íñiguez, Carmen

AU - Forsberg, Bertil

AU - Ragettli, Martina S.

AU - Guo, Yue Leon

AU - Pan, Shih Chun

AU - Osorio, Samuel

AU - Li, Shanshan

AU - Zanobetti, Antonella

AU - Dang, Tran Ngoc

AU - Van Dung, Do

AU - Schneider, Alexandra

PY - 2024

Y1 - 2024

N2 - OBJECTIVE To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN Two stage time series analysis. SETTING 645 locations across 34 countries or regions. POPULATION Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS During the study period, a total of 50913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk <1) with moderate-heavy rainfall events, shifting to adverse effects (relative risk >1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure.

AB - OBJECTIVE To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN Two stage time series analysis. SETTING 645 locations across 34 countries or regions. POPULATION Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS During the study period, a total of 50913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk <1) with moderate-heavy rainfall events, shifting to adverse effects (relative risk >1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure.

UR - https://www.scopus.com/pages/publications/85205997959

U2 - 10.1136/bmj-2024-080944

DO - 10.1136/bmj-2024-080944

M3 - Artículo

C2 - 39384295

AN - SCOPUS:85205997959

SN - 0959-8146

VL - 387

JO - BMJ

JF - BMJ

M1 - e080944

ER -

Rainfall events and daily mortality across 645 global locations: two stage time series analysis

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