Establishing and mapping heat-sensitive disease spectrum in eastern China: A comprehensive analysis of 1.4 million deaths involving 14 major disease categories

BACKGROUND: Although high temperatures can affect multiple systems and organs, the comprehensive assessment of heat-sensitive diseases remains unclear. We aimed to establish the heat-related sensitive disease spectrum and assess the relative importance of affected diseases from the health risk and burden perspectives. METHODS: A space-time-stratified case-crossover analysis was used to examine the short-term association between high temperatures and cause-specific deaths in Jiangsu Province, China during the warm season of 2016 to 2019. A total of 14 major disease categories and 29 specific diseases were tested to identify heat-sensitive diseases. A multi-level comparison of heat-affected diseases was conducted based on the health risk and burden indicators including mortality risk, years of life lost (YLL) to measure disease burden, and value of YLL (VYLL) to measure economic burden. RESULTS: High temperatures were associated with an increased risk of mortality from 23 specific diseases involving 12 major disease categories, including well-studied cardiovascular, respiratory, endocrine, and nervous diseases, and less-studied skin, urinary system diseases, mental and behavioral disorders, external causes, injury and poisoning, symptoms, signs and abnormal clinical, and neoplasms. The top three greatest heat-related risks of mortality from major disease categories were skin system (OR: 1.72, 95 % CI: 1.37-2.36), external causes of mortality (OR: 1.71, 95 % CI: 1.57-1.87), and nervous system (OR: 1.46, 95 % CI: 1.26-1.68), and cause-specific diseases were asthma (OR: 2.26, 95 % CI: 1.46-3.50), accidental drowning (OR: 1.85, 95 % CI: 1.42-2.40), and acute respiratory infections (OR: 1.80, 95 % CI: 1.02-3.16). In terms of both disease and economic burdens attributable to heat, cardiovascular diseases contributed to the greatest proportion, followed by neoplasms, external causes, and respiratory diseases. Within specific diseases, cerebrovascular diseases contributed the greatest disease and economic burdens, followed by ischemic heart disease, lung (neoplasm), and COPD. Furthermore, the largest heat-related reduction in life expectancy reached 5.27 years for external causes and 12.96 years for accidental drowning. CONCLUSION: This study provides a heat-sensitive disease spectrum and resulting death risk and burden vary by different systems and specific diseases. Our findings may have implications for implementing heat-health action plans to mitigate the adverse effects of heat-sensitive diseases.