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Cited by 325Climate Change and Health ImpactsThermoregulation and physiological responsesAir Quality and Health Impacts

Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave

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Azhar, Gulrez Shah, Mavalankar, Dileep, Nori-Sarma, Amruta, Rajiva, Ajit, Dutta, Priya, Jaiswal, Anjali, Sheffield, Perry, Knowlton, Kim +2 more·2014·PLoS ONE
DOI 10.1371/journal.pone.0091831PMC PMC3954798
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Abstract

INTRODUCTION: In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8 °C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. METHODS: We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1-31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. RESULTS: The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest "summer" months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19-25, 2010), mortality rate ratios were 1.76 [95% CI 1.67-1.83, p<0.001] and 2.12 [95% CI 2.03-2.21] applying reference periods (May 12-18, 2010) from various years. CONCLUSION: The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June.

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  • Studies from India and Pakistan qualified heatwaves based on a direct temperature threshold, i.e., daily maximum temperature ranged between 40 to 45°C without considering duration or periods.

    “Studies from India and Pakistan qualified heatwaves based on a direct temperature threshold, i.e., the daily maximum temperature ranged between 40 to 45 • C without considering duration or periods [34,36].”

    From Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies (2022) · cites this paper as [36]

    The Introduction describes Indian heat-wave criteria based on daily maximum temperature, including an absolute threshold above 45°C. It does not give 40–45°C as the qualifying range: the Ahmedabad days it identifies reached 44.5–46.8°C. The Methods also explicitly analyzes a four-day extreme-heat period within a specified week, so the claim that the study did not consider periods is unsupported. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The body of literature supports that a heatwave warning system can be an effective tool in reducing heat-related mortality and morbidity.

    “The body of literature supports the notion that a heatwave warning system can be an effective tool in reducing heat-related mortality and morbidity [36,124].”

    From Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies (2022) · cites this paper as [36]

    The Discussion (page unavailable in our copy) says that early heat warnings might significantly reduce heat-related deaths, especially when paired with preparedness and response measures. It does not say that warning systems reduce heat-related morbidity or report an evaluation of their effectiveness. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Awareness, education, and public outreach activities via government training workshops, billboards, pamphlets, and print advertisements are necessary to disseminate the severity of heat stress.

    “Further, awareness, education, and public outreach activities via government training workshops, billboards, pamphlets, and print advertisements are also necessary to disseminate the severity of heat stress [36,77].”

    From Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies (2022) · cites this paper as [36]

    The Discussion says public awareness of heat’s harmful health effects is critical and calls for preparedness among medical, public-health, and city-government staff. It does not specify government training workshops, billboards, pamphlets, or print advertisements as necessary ways to communicate that message. No page number is available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Increasing access to water at different city locations is a solution for LMICs to reduce heat-related health hazards.

    “Another solution for LMICs is increasing access to water (via keeping water pots/tanks) at different city locations to reduce heat-related health hazards [36,77].”

    From Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies (2022) · cites this paper as [36]

    The Discussion (page unavailable) recommends that public-awareness messages encourage people to maintain hydration to protect against heat. It does not propose increasing access to water through pots or tanks at city locations, so the specific solution attributed to this paper is unsupported. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • A successful case study from the Ahmedabad HAP advocated integration of meteorological and healthcare departments for substantial heatwave preparedness.

    “A successful case study from Ahmedabad HAP advocated the integration of meteorological and healthcare departments for substantial heatwave preparedness [36].”

    From Heatwaves in South Asia: Characterization, Consequences on Human Health, and Adaptation Strategies (2022) · cites this paper as [36]

    The Discussion advocates coordination across city government and medical facilities, along with information-sharing among agencies, to improve heat preparedness. But the Introduction describes this paper as a mortality analysis and an early step toward adaptation; our copy does not present it as a successful evaluation of the Ahmedabad Heat Action Plan or specifically call for integrating meteorological and healthcare departments. The indexed passages provide section labels but no page numbers. (LLM, conf=0.86)

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Authors
Azhar, G. S., Mavalankar, D., Nori-Sarma, A., Rajiva, A., Dutta, P., Jaiswal, A., Sheffield, P., Knowlton, K., Hess, J. J., & on behalf of the Ahmedabad HeatClimate Study Group
Affiliations
  • Public Health Foundation of India (IN)
  • Natural Resources Defense Council (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Emory University (US)
Corresponding author
Azhar, Gulrez Shah
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-03-14
Volume
9
Issue
3
Pages
e91831
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0091831
PMC
PMC3954798
OpenAlex
W2074522551
Cited by
325
References
40
Citations by year
2026: 37 · 2025: 29 · 2024: 27 · 2023: 42 · 2022: 42 · 2021: 38 · 2020: 22 · 2019: 24 · 2018: 31 · 2017: 12 · 2016: 10 · 2015: 5 · 2014: 5
FWCI
7.01
Type
journal article
Language
en
Update notices
correction (2014-09-25)
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Georgia Institute of Technology
  • Emory University
  • Public Health Foundation of India
  • Fogarty International Center (R21TW009535)
  • National Institute of Environmental Health Sciences (P30ES023515)
  • Institute of Indigenous Peoples' Health
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
  • Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Keywords
heat-related mortality, extreme heat, daily maximum temperature, mortality rate ratio, developing countries, South Asia, urban heat exposure, Gujarat, India, health impacts of climate change
MeSH terms
Cause of Death, Female, Hot Temperature, Humans, India, Male, Mortality, Seasons, Heat Stress Disorders

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