{
  "abstract": "Abstract Objective To characterise and quantify the mortality risks for a range of causes after tropical cyclones in nine countries and territories.Design Two stage, time series study.Setting Nine countries or territories (Australia, Brazil, Canada, South Korea, Mexico, New Zealand, the Philippines, Taiwan, and Thailand), covering tropical, subtropical, and extra-tropical regions.Participants General populations living in regions with tropical cyclones in the nine countries or territories, 2000-19.Main outcomes measures Excess mortality risk of cardiovascular diseases, respiratory diseases, infectious diseases, injuries, neuropsychiatric disorders, renal diseases, digestive diseases, diabetes, and neoplasms as the leading cause of death. Wind speed and rainfall profiles were quantified with a physics based tropical cyclone field model.Results 14.8 million deaths and 217 tropical cyclone events in communities from the nine countries or territories were included in the analysis. Mortality risks from various causes consistently increased after tropical cyclones, with peaks occurring within the first two weeks after the cyclone, followed by a rapid decline. During the first two weeks after a tropical cyclone, the highest increases were seen in mortality from renal diseases and injuries, with a cumulative relative risk of 1.92 (95% confidence interval (CI) 1.63 to 2.26) and 1.21 (1.12 to 1.30), respectively, for each additional tropical cyclone day. Relatively more modest risks were found for mortality from diabetes (cumulative relative risk 1.15, 95% CI 1.08 to 1.21), neuropsychiatric disorders (1.12, 1.05 to 1.19), infectious diseases (1.11, 1.05 to 1.17), digestive diseases (1.06, 1.02 to 1.09), respiratory diseases (1.04, 1.00 to 1.08), cardiovascular diseases (1.02, 1.01 to 1.04), and neoplasms (1.02, 1.00 to 1.04). Mortality risks were substantially higher in communities with greater levels of deprivation and in those with historically fewer tropical cyclones, especially for renal, infectious, and digestive diseases, as well as for diabetes. Rainfall related to tropical cyclones had a more consistent increasing exposure-response relation with mortality risks, particularly for deaths related to respiratory, cardiovascular, and infectious diseases.Conclusions After tropical cyclones, mortality risk increased variably for different causes, populations, and regions. Integrating epidemiological evidence into the development of management systems for climate extremes is urgently needed, particularly in regions with higher levels of deprivation and in those with historically fewer tropical cyclones. These measures are necessary to improve the adaptive capacity in responding to the growing risks and shifting activity of tropical cyclones in a warming climate.",
  "authors": [
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Wenzhong Huang"
    },
    {
      "affiliations": [
        "Chongqing Emergency Medical Centre, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China",
        "School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC 3004, Australia"
      ],
      "name": "Rongbin Xu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Zhengyu Yang"
    },
    {
      "affiliations": [
        "Potsdam Institute for Climate Impact Research, Potsdam, Germany"
      ],
      "name": "Christian Otto"
    },
    {
      "affiliations": [
        "Department of Public Health, University of Otago, Wellington, New Zealand"
      ],
      "name": "Simon Hales"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Samuel Hundessa"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Tingting Ye"
    },
    {
      "affiliations": [
        "Department of Global Health Policy Graduate School of Medicine, University of Tokyo, Tokyo, Japan"
      ],
      "name": "Paul L C Chua"
    },
    {
      "affiliations": [
        "School of Earth Atmosphere and Environment, Monash University, Melbourne, VIC, Australia",
        "Australian Research Council Centre of Excellence for Weather of the 21st Century, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Elizabeth A Ritchie"
    },
    {
      "affiliations": [
        "Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Micheline S Z S Coelho"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Pei Yu"
    },
    {
      "affiliations": [
        "Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Krung Thep Maha Nakhon, Thailand"
      ],
      "name": "Kraichat Tantrakarnapa"
    },
    {
      "affiliations": [
        "Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Paulo H N Saldiva"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yiwen Zhang"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Zhihu Xu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Shuang Zhou"
    },
    {
      "affiliations": [
        "Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada",
        "School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada"
      ],
      "name": "Eric Lavigne"
    },
    {
      "affiliations": [
        "Department of Global Health, Nagasaki University, Nagasaki, Japan",
        "Department of Hygiene, Graduate School of Medicine, Hokkaido University, Sapporo, Japan"
      ],
      "name": "Xerxes Tesoro Seposo"
    },
    {
      "affiliations": [
        "Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Krung Thep Maha Nakhon, Thailand"
      ],
      "name": "Wissanupong Kliengchuay"
    },
    {
      "affiliations": [
        "Department of Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan",
        "National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan",
        "Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan"
      ],
      "name": "Yue Leon Guo"
    },
    {
      "affiliations": [
        "Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea",
        "Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea"
      ],
      "name": "Ho Kim"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Wenhua Yu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yanming Liu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Ke Ju"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yao Wu"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Bo Wen"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Shanshan Li"
    },
    {
      "affiliations": [
        "Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"
      ],
      "name": "Yuming Guo"
    }
  ],
  "title": "Cause specific mortality risks associated with tropical cyclones in multiple countries and territories: two stage, time series study",
  "uid": "18c767c5-7a89-58ca-998b-d2f46a822b37"
}