Cited by 148Climate Change and Health ImpactsThermoregulation and physiological responsesEffects of Environmental Stressors on Livestock

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Twenty-Seven Ways a Heat Wave Can Kill You: Deadly Heat in the Era of Climate Change

Mora, Camilo, Counsell, Chelsie W.W., Bielecki, Coral R., Louis, Leo V·2017·Circulation: Cardiovascular Quality and Outcomes

DOI 10.1161/circoutcomes.117.004233

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THE WORLD METEOROLOGICAL ORGANIZATION
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“…conflict, reduced educational attainment, morbidity, and reduced labor productivity (Burke et al. 2009, Kelley et al. 2015, Schleussner et al. 2016, Mora et al. 2017a, Randell & Gray 2019), both now and in the future (Jendritzky & Tinz 2009, Sherwood & Huber 2010, Field et al. 2012, Seneviratne et…”
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Tackling climate change with machine learning
Rolnick, D., Donti, P. L., Kaack, L. H., Kochanski, K., Lacoste, A., Sankaran, K., Ross, A. S., Milojevic-Dupont, N., Jaques, N., Waldman-Brown, A., et al. (2023) · ACM Computing Surveys · doi:10.1145/3485128 · Cited by 336
“[267] Camilo Mora, Chelsie WW Counsell, Coral R Bielecki, and Leo V Louis.”
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Humid heat and climate change
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“Extreme heat can affect cardiovascular and respiratory health (Gronlund et al., 2018; Mora et al., 2017), but these impacts are not included in our analysis.”
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“47,48 Conversely, a drop in core body temperature can lead to decreased heart rate, an increase in sympathetic response and vasoconstriction, catecholamine-driven rise in blood pressure, and electro-physiological disturbances.”
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“For example, damage due to tropical cyclones depends on both the storm characteristics and on the local situation at landfall (Pielke et al 2008); the danger of extreme heat is related to local demographics and social context (Reid et al 2009, Mora et al 2017).”
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“…considered in the context of tropical cities goes beyond deaths related to heat stress, also including heat stress driven worsening of cardiovascular, diabetic, and respiratory conditions, as well as economic impacts caused by the loss of hours of labor (Camilo et al. 2017; Watts et al. 2018).”
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Benmarhnia, T., Schwarz, L., Nori‐Sarma, A., & Bell, M. L. (2019) · Environmental Research Letters · doi:10.1088/1748-9326/ab402e · Cited by 52
“Health consequences range from heat exhaustion to death (Bouchama et al 2007, Mora et al 2017).”
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Household income inequality aggravates high-temperature exposure inequality in urban China
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“Consequently, low-grade systemic inﬂammation potentiates endothelial injury, cytotoxicity, ischemia, and intravascular coagulation that leads to organ failure, disability, and death in healthy populations (Mora et al., 2017; Hansson et al., 2020; Clauss et al., 2021).”
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“Further, temperatures in tropical forests in low-latitude countries, where high heat and humidity are present, are already approaching thresholds for human safety [40].”
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“17,45 Under conditions of heat stress, the body activates heat loss responses of cutaneous vasodilation and sweat production (which subsequently evap-orates and removes body heat) to limit elevations in core temperature, which can affect people differently based on, for example, age, pre-existing…”
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“46 Regarding one of the Environmental Health Perspectives 057009-13 131(5) May 2023 respiratory outcomes assessed in this study, the most common cause of bacterial pneumonia worldwide is Streptococcus pneumoniae , 47 which thrives at temperatures between 30°C and 35°C (86°F and 95°F).”
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“Mora et al. (2017) pointed out that HWs might lead to at least 27 deadly physiological pathways.”
Background
Psychological Impacts of Climate Change and Recommendations
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“31 During a heatwave, the body attempts to cool itself through sweating and vasodilation, but prolonged or excessive heat exposure can overwhelm these systems.”
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“This may lead to critical damage in various organs, including the heart, brain, liver, and kidneys [13]. responses, which are Smoke pollution and poor air quality from landscape ﬁres are globally signiﬁcant public health problems [14]. common diseases including ischemic heart disease, stroke,…”
Background
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“…heat stress (Coffel et al 2018, Li et al 2020)—the combination of temperature and other climate variables, like humidity, known to negatively affect the human body’s functioning in hot weather—with major implications for human health (Hanna and Tait 2015, Kjellstrom et al 2016, Mora et al 2017).”
Background
Association between thermal stress and cardiovascular mortality in the subtropics
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“Stress on the circulatory system can be exacerbated by heat-induced dehydration, followed by increased blood viscosity and vaso-constriction which increase the risk of coronary thrombosis and stroke (Liu et al. 2015; Mora et al. 2017; Yu et al. 2011).”
Background
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“This type of situation has seemed to evolve periodically during recent decades, linked to the consequences of climate change (Cubasch et al., 2013; Liss et al., 2017; Mora et al., 2017).”
Background
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Barnes, J., Sheffield, P. E., Graber, N. M., Jessel, S., Lanza, K., Limaye, V. S., Morrow, F., Sauthoff, A., Schmeltz, M. T., Smith, S., et al. (2024) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.15244 · Cited by 12
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Developing a thermal stress map of Iran through modeling a combination of bioclimatic indices
Roshan, G., Faghani, M., & Fitchett, J. M. (2020) · Environmental Monitoring and Assessment · doi:10.1007/s10661-020-08503-y · Cited by 11
“…and remaining within shaded areas, and longer-term infrastructural adaptation at household through to national levels, including thermal controls such as air conditioning, effective insulation, building with reference to heat influx, and reduction in the urban heat island (Mora et al. 2017a).”
Background
Spatiotemporal variation of heat and cold waves and their potential relation with the large-scale atmospheric circulation across Inner Mongolia, China
Guo, E., Wang, Y., Bao, Y., Sun, Z., Bao, Y., & Lai, Q. (2020) · Theoretical and Applied Climatology · doi:10.1007/s00704-020-03331-z · Cited by 12
“For instance, Mora et al. (2017) pointed out that HWs might lead to at least 27 deadly physiological pathways; in the past 10 years, the life losses of human beings have increased by 2300% due to HWs. Herring et al. (2014) suggested that climate change had obviously aggregated the severity of HWs…”
Background
Overheated and Understudied: A Scoping Review of Heat‐Related Health Impacts in the Arabian Peninsula
Teyton, A., Bailey, J., Luo, E., Ajaj, R., Raymond, C., Tuholske, C. P., & Benmarhnia, T. (2025) · GeoHealth · doi:10.1029/2024gh001277 · Cited by 10
“These issues include but are not limited to direct health outcomes, such as heat exhaustion and heat stroke, as well as indirect health outcomes, such as exacerbations of cardiovascular and respiratory diseases, which can result in death (Ebi et al., 2021; Mora, Counsell et al., 2017).”
Changing Degrees: Incorporating the Impacts of Climate Change on Health into Pediatric Residency Education and Practice
Gauthier, S. J. (2023) · The Yale Journal of Biology and Medicine · doi:10.59249/bsgy1262 · Cited by 10
Temperature-related chest pain presentations and future projections with climate change
Dawson, L. P., Andrew, E., Nehme, Z., Bloom, J. E., Cox, S., Anderson, D. J., Stephenson, M., Lefkovits, J., Taylor, A. J., Kaye, D. M., et al. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.157716 · Cited by 9
Simultaneous Drought and Heatwave Events During Austral Summer in Northeast Brazil
Bezerra, K. F. D. S., Gomes, H. B., Baltaci, H., Ray, P., Nascimento, J. P., Herdies, D. L., Lyra, M. J. A., da Silva, M. C. L., Silva, F. D. D. S., Silva, C. M. S. E., et al. (2025) · International Journal of Climatology · doi:10.1002/joc.8920 · Cited by 8
“…the peak years, it still showed significant occurrences of heatwaves compared to the previous 3 years, aligning with global patterns that associate increasing temperatures and global warming with more frequent and intense heatwaves (Geirinhas et al. 2017; Mora et al. 2017; Bitencourt et al. 2020).”
Compounding effects of heat and high humidity on cardiovascular morbidity in Dhaka, Bangladesh: An implication of climate crisis
Rahman, M. M., Mckeon, K. L., Luglio, D. G., Hossain, C. A., Rabito, F. A., Alam, N., Morrow, N., Gonzales, M., & Thurston, G. D. (2025) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2025.180220 · Cited by 7
Heat waves and annual mortality among older adults (aged ≥65 years) in the USA
Healy, J. P., Castro, E., Yazdi, M. D., Rice, M. B., Chang, H. H., Steenland, K., Wei, Y., & Schwartz, J. D. (2026) · The Lancet Planetary Health · doi:10.1016/j.lanplh.2026.101432 · Cited by 7
The Dipole Mode of Summer Wet‐Bulb Temperature Over Eastern China and the Possible Mechanisms
He, W., & Chen, H. (2024) · Journal of Geophysical Research Atmospheres · doi:10.1029/2023jd040399 · Cited by 8
Environmental sustainability in healthcare: impacts of climate change, challenges and opportunities
Koh, E. Y.-P., Chan, W. F., Lim, H. C. S., Tan, B. K. T., Ong, C. T.-M., Singh, P. A., Tan, M. B. H., Sim, M. J. H., Ong, L. W., Tan, H., et al. (2025) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2025-050 · Cited by 6
“[26,27] Heat stress may cause higher perioperative complication rates, with one case–control series from India suggesting that increased ambient temperatures worsened perioperative outcomes in trauma patients.”
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The climate impact of dialysis
Phua, E., & Shen, Y. (2023) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000940 · Cited by 6
“…&& ] Even within the last two decades, deaths of more matter of days in the north and north-eastern states of India when temperatures rose above 45 8 C, with the World Health Organisation (WHO) estimating an additional 250 000 deaths per year in the next 20 years due to climate change alone [8–10].”
Background
Are Big Cities Ready to Mitigate Climate Change? Evidence from Sydney, Australia
Göçer, Ö., Roy, A., Haddad, S., Deb, C., & Astell‐Burt, T. (2024) · Climate · doi:10.3390/cli12090137 · Cited by 6
Pharmacodynamic evaluation and network pharmacology analysis of a novel anti-heat stress Chinese herbal formula
Wang, H., Xu, S., Mao, H., Wang, B., Feng, Y., Ihsan, A., Li, S., & Wang, X. (2024) · Animal Diseases · doi:10.1186/s44149-024-00144-9 · Cited by 6
“…exposure to high temperatures has the potential to trigger physiological mechanisms such as ischemia, inflammatory responses and rhabdomyolysis, and many other vital organs, such as the brain, heart and liver, can be severely affected (Mora et al. 2017; Munguia et al. 2024; Umemura et al. 2018).”
Background
Heat, Mortality, and Health
Randell, H. (2022) · International handbooks of population · doi:10.1007/978-3-030-76433-3_14 · Cited by 6
Temporal variations of the association between summer season heat exposure and hospitalizations for renal diseases in Queensland, Australia, 1995–2016
Lu, P., Miao, J., Feng, S., Green, D., Lim, Y., Gao, X., Li, S., & Guo, Y. (2022) · Environmental Research Letters · doi:10.1088/1748-9326/ac72b8 · Cited by 6
Dynamic heart rate response to multi‐day unsupported ultra‐endurance cycle racing: a case report
Brayson, D., Frigiola, A., & Clark, J. (2018) · Experimental Physiology · doi:10.1113/ep087341 · Cited by 7
Universal or targeted approaches? an experiment about heat risk messaging
Li, Y., & Howe, P. D. (2023) · Natural Hazards · doi:10.1007/s11069-023-05864-8 · Cited by 6
Obvious difference of dominant circulation patterns between dry‐type and humid‐type heatwaves in North China
Ding, T., Gao, H., & Xie, T. (2024) · International Journal of Climatology · doi:10.1002/joc.8605 · Cited by 5
“…have higher risks to humans and wildlife relative to dry HDs, as high humidity reduces the efficiency of evaporative cooling and, when combined with elevated air temperature, can undermine this cooling mechanism and pose a serious threat to human health (Li et al., 2020; Mora et al., 2017).”
Primary Prevention of Coronary and Other Cardiovascular Diseases: A Focused Review
Higashiyama, A., Kohsaka, S., & Fujiyoshi, A. (2024) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.rv22019 · Cited by 6
“The potential mechanisms by which heat causes CV events encompass various factors, including dehydration leading to increased blood viscosity and vasoconstriction 76) .”
Background
Does carbon emission trading contribute to reducing infectious diseases? Evidence from China
Hao, Y., Li, Y., & Shen, Z. (2022) · Growth and Change · doi:10.1111/grow.12633 · Cited by 5
A weakened Atlantic Meridional Overturning Circulation will affect future heat waves by mostly attenuating their severity
Pinto, D. D. C., Liu, W., & Zhang, L. (2025) · Climate Dynamics · doi:10.1007/s00382-025-07736-2 · Cited by 5
Modeling heatwave trends from land cover dynamics using satellite observations and machine learning in Ibadan, Nigeria
Ikuemonisan, F. E., Kayode, Y. O., Ogunjo, S. T., Odubote, O. B., & Okedeyi, S. A. (2025) · Discover Geoscience · doi:10.1007/s44288-025-00361-w · Cited by 4
“…temperatures substantially increases the risk of heat-related illnesses such as heatstroke, dehydration, and heat exhaustion, with particularly severe outcomes for vulnerable populations including the elderly, children, and individuals with pre-existing conditions [23, 45, 80, 123, 124, 143].”
In-hospital mortality of heat-related disease associated with wet bulb globe temperature: a Japanese nationwide inpatient data analysis
Nakamura, K., Okada, A., Watanabe, H., Oka, K., Honda, Y., Matsui, H., Fushimi, K., Yasunaga, H., & Kim, Y. (2025) · International Journal of Biometeorology · doi:10.1007/s00484-025-02867-x · Cited by 4
“Heat-related diseases can potentially lead to death caused by multiple organ failure and have become an important public health issue as global warming progresses (Mora et al. 2017; Sorensen and Hess 2022).”
Hitzewellen und Klimawandel: Eine Herausforderung für Gesundheitsberufe
Schoierer, J., Wershofen, B., Böse‐O’Reilly, S., & Mertes, H. (2020) · Public Health Forum · doi:10.1515/pubhef-2019-0118 · Cited by 4
Detecting spatial heat vulnerability in the city considering spatiotemporal population distribution: A focus on the elderly during daytime
Lee, S., Lee, J. S., & Kim, S. (2024) · Urban Climate · doi:10.1016/j.uclim.2024.102054 · Cited by 4
Development of a New Generalizable, Multivariate, and Physical-Body-Response-Based Extreme Heatwave Index
Cataldi, M., Galves, V. L. V., Sphaier, L. A., Garnés-Morales, G., Gallardo, V., Molina-Párraga, L., Montávez, J. P., & Jiménez‐Guerrero, P. (2024) · Atmosphere · doi:10.3390/atmos15121541 · Cited by 3
“HW episodes that are intense and persistent enough to directly impact human health will be referred to in this study as extreme heatwave episodes (XHWIs), drawing on previous studies that have similarly classified intense and prolonged episodes [30,31].”
Impacts sanitaires du changement climatique : données récentes, éléments de réflexion
Hachad, H., & Depoux, A. (2021) · La Presse Médicale Formation · doi:10.1016/j.lpmfor.2021.10.020 · Cited by 5
A Climatology of Summertime Wet-Bulb Globe Temperature in California’s Imperial Valley
Thompson, C. F., Jones, C., Biggs, T. W., Quintana, P. J. E., Zavala, M., Sales, F. D., Roberts, D. A., Parajuli, S., Ciborowski, H. M., & McMahon, C. (2025) · Journal of Applied Meteorology and Climatology · doi:10.1175/jamc-d-24-0199.1 · Cited by 3
Incidence and burden of cardiovascular disease attributable to extreme heat in China
Pei, X., Tang, H., Zheng, C., Zhang, Y., Sun, M., Jia, Q., Liu, S., Wang, X., Tian, Y. F., Cao, X., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf643 · Cited by 3
The role of climate services for health: Theoretical case studies on heat-health warning systems in India
Rizmie, D., Christo, E., Carosella, E. A., Almstead, L., Bhinge, M., & Sivasankaran, A. (2025) · PLOS Climate · doi:10.1371/journal.pclm.0000637 · Cited by 3
Occupational characteristics are missing from heat vulnerability indices: a study in New York and New Jersey
Laskaris, Z., Baron, S., & Markowitz, S. B. (2026) · Environmental Health · doi:10.1186/s12940-026-01284-w · Cited by 3
“[ 85] These findings highlight the added value of implementing workplace heat protections for all workers, especially in regions like upstate NY, where occupational heat exposure and chronic health conditions are both prevalent.”

Authors: Mora, C., Counsell, C. W. W., Bielecki, C. R., & Louis, L. V.
Affiliations: University of Hawaiʻi at Mānoa (US)
ORCID: Mora, Camilo
Counsell, Chelsie W.W.
Louis, Leo V
Venue: Circulation: Cardiovascular Quality and Outcomes
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-11
Volume: 10
Issue: 11
ISSN: 1941-7705 (ISSN-L)
1941-7713
DOI: 10.1161/circoutcomes.117.004233
OpenAlex: W2767615108
Cited by: 148
References: 9
Citations by year: 2026: 20 · 2025: 23 · 2024: 24 · 2023: 17 · 2022: 15 · 2021: 17 · 2020: 14 · 2019: 13 · 2018: 4 · 2017: 1
Type: journal article
Language: en
Open access: closed
Locations: Circulation Cardiovascular Quality and Outcomes (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
Health Sciences › Medicine › Physiology (medical) › Thermoregulation and physiological responses
Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Effects of Environmental Stressors on Livestock
Keywords: heat waves, heat-related mortality, cardiovascular mortality, heat stress, cardiovascular disease
MeSH terms: Animals, Body Temperature Regulation, Cause of Death, Environmental Exposure, Hot Temperature, Humans, Prognosis, Risk Factors, Risk Assessment, Heat Stress Disorders, Climate Change

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