Projecting future excess deaths associated with extreme precipitation events in China under changing climate: an integrated modelling study

Climate-change-induced extreme precipitation events have attracted global attention; however, the associated excess deaths burden has been insufficiently explored and remains unclear. We first defined an extreme precipitation event for each county when the daily total precipitation exceeded the county-specific 99·5th percentile of the daily precipitation from 1986 to 2005; then we estimated the associations between extreme precipitation events and cause-specific deaths in 280 Chinese counties using a two-stage time-series model. Second, we projected the excess deaths related to extreme precipitation events by combining the bias-corrected multi-model precipitation predictions derived under different combined emission-population scenarios of three representative concentration pathways (RCPs; RCP2·6, RCP4·5, and RCP8·5) and three shared socioeconomic pathways (SSP2, a business-as-usual scenario) populations (S1, low fertility rate; S2, medium fertility rate; and S3, high fertility rate). We quantified the climate and population contributions to the changes of future excess deaths nationwide and by climatic zones. Compared with the non-extreme precipitation days, the percentage increase of deaths associated with exposure to extreme precipitation days is 13·0% (95% CI 7·0–19·3) for accidental cause, 4·3% (2·0–6·6) for circulatory disease, and 6·8% (2·8–10·9) for respiratory disease. The number of annual average excess deaths related to extreme precipitation events during 1986–2005 was 2644 (95% CI 1496–3730) for accidental cause, 69 (33–105) for circulatory disease, and 181 (79–279) for respiratory disease. In the 2030s, the total number of excess deaths of these three causes will increase by 1244 (43%), 1756 (61%), and 2008 (69%) under RCP2·6, RCP4·5, and RCP8·5 scenarios combined with a medium-fertility-rate population (SSP2-S2), respectively, but will decrease by 3% under RCP2·6–SSP2-S2 and increase by 25% under RCP8·5–SSP2-S2 in the 2090s. Humid and water-limited regions in subtropical, middle-temperate, and plateau climate zones will face highly increased risks. Climate and population factors contributed disproportionally among the five climate zones. This study is the largest integrated projection exploring the disease burden associated with extreme precipitation events. The excess deaths will be amplified by climate and population changes. Improving mitigation and adaptation capacities is crucial when responding to precipitation extremes. National Natura