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Variation in reporting of heatstroke mortality: evidence from a multi-country study

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Resumo(s)

Background: Heatstroke represents the most severe manifestation of heat exposure. Heatstroke is rare and under-reported, resulting in limited empirical data on its global incidence and burden. This study aimed to examine geographical variations and temporal trends in reported heatstroke mortality across multiple countries. Methods: We collected annual heatstroke mortality data from 34 countries participating in the Multi-Country Multi-City Collaborative Research Network between 2000 and 2022, using the ICD-10 code X30. Country-specific mortality rates were estimated using Poisson regression, alongside analyses of annual trends and associations with mean warm-season temperature. We also assessed the proportion of heatstroke deaths relative to both overall heat and extreme heat-attributable all-cause mortality. Findings: Heatstroke mortality rates varied widely across countries, with Japan reporting the highest rate (5·81 per 1 million population; 95% CI 4·43-7·62), followed by Cyprus (2·51; 1·36-4·61), and China (2·42; 1·21-4·85). By contrast, most countries in Europe, South America, and southeast Asia reported rates of less than one death per 1 million population. Heatstroke mortality increased over time in several countries and was associated with warm-season temperatures in most regions. The proportion of heatstroke deaths relative to overall heat-attributable mortality ranged from less than 1% in many countries to as close to 24% in Japan. When analyses were restricted to deaths attributable to extreme heat, the proportion of heatstroke deaths increased substantially. Interpretation: Our broad international assessment of heatstroke mortality highlights its distinct patterns compared with overall heat-attributable mortality. The observed variability likely reflects differences in recognition, reporting, and diagnostic practices, while climate exposure and health system capacity influence whether heat-related deaths are identified and recorded as heatstroke.

Descrição

Erratum in: Lancet Public Health. 2026 Apr;11(4):e211. doi: 10.1016/S2468-2667(26)00058-7
Multi-City Multi-Country Collaborative Research Network: Rosana Abrutzky, Souzana Achilleos, Fiorella Acquaotta, Barrak Alahmad, Ben Armstrong, Hanne Krage-Carlsen, Gabriel Carrasco, Paul Lester Carlos Chua, Micheline de Sousa Zanotti Stagliorio Coelho, Valentina Colistro, Susana das Neves Pereira da Silva, Francesca D e'Donato, Bertil Forsberg, Antonio Gasparrini, Yue Leon Guo, Yuming Guo, Iván Gutierrez-Avila, Masahiro Hashizume, Iulian-Horia Holobaca, Yasushi Honda, Veronika Huber, Magali Hurtado Diaz, Carmen Íñiguez, Haidong Kan, Ho Kim, Yoonhee Kim, Wissanupong Kliengchuay, Jan Kyselý, Eric Lavigne, Whanhee Lee, Yuanyu Lu, Lina Madaniyazi, Joana Madureira, Pierre Masselot, Patricia Matus Correa, Paola Michelozzi, Chris Fook Sheng Ng, Samuel Osorio, Ala Overcenco, Shih-Chun Pan, Robin Park, Robbie M Parks, Mathilde Pascal, Martina S Ragettl, Dominic Roye, Paulo Hilario Nascimento Saldiva, Alexandra Schneider, Joel Schwartz, Noah Scovronick, Xerxes Seposo, Francesco Sera, Muhammad Abdul Basit Ahmad Tajudin, Kraichat Tantrakarnapa, Aurelio Tobias, Shilu Tong, Aleš Urban, Nicolás Valdés Ortega, Ana M Vicedo-Cabrera, Antonella Zanobetti.

Palavras-chave

Heat Stroke Mortality MCC Multi Country Multi City Global Health Determinantes da Saúde e da Doença

Contexto Educativo

Citação

Lancet Public Health. 2026 Mar;11(3):e156-e163. doi: 10.1016/S2468-2667(25)00322-6

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Editora

Elsevier

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