The impact of heat waves on mortality in seven major cities in Korea

Background: Understanding the health impacts of heat waves is important, especially given anticipated increases in the frequency, duration, and intensity of heat waves due to climate change. Objectives: We examined mortality from heat waves in seven major Korean cities for 2000 through 2007 and investigated effect modification by individual characteristics and heat wave characteristics (intensity, duration, and timing in season). Methods: Heat waves were defined as ≥ 2 consecutive days with daily mean temperature at or above the 98th percentile for the warm season in each city. We compared mortality during heat-wave days and non-heat-wave days using city-specific generalized linear models. We used Bayesian hierarchical models to estimate overall effects within and across all cities. In addition, we estimated effects of heat wave characteristics and effects according to cause of death and examined effect modification by individual characteristics for Seoul. Results: Overall, total mortality increased 4.1% [95% confidence interval (CI): -6.1%, 15.4%] during heat waves compared with non-heat-wave days, with an 8.4% increase (95% CI: 0.1%, 17.3%) estimated for Seoul. Estimated mortality was higher for heat waves that were more intense, longer, or earlier in summer, although effects were not statistically significant. Estimated risks were higher for women versus men, older versus younger residents, those with no education versus some education, and deaths that occurred out of hospitals in Seoul, although differences among strata of individual characteristics were not statistically significant. Conclusions: Our findings support evidence of mortality impacts from heat waves and have implications for efforts to reduce the public health burden of heat waves.