title: Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Indian Institute of Public Health, Ahmedabad, Gujarat, India; Public Health Foundation of India, New Delhi, India.
authors.forename: Gulrez Shah
authors.initials: GS
authors.lastname: Azhar
authors.affiliation: Indian Institute of Public Health, Ahmedabad, Gujarat, India; Public Health Foundation of India, New Delhi, India.
authors.forename: Dileep
authors.initials: D
authors.lastname: Mavalankar
authors.affiliation: Indian Institute of Public Health, Ahmedabad, Gujarat, India; Columbia Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Amruta
authors.initials: A
authors.lastname: Nori-Sarma
authors.affiliation: Indian Institute of Public Health, Ahmedabad, Gujarat, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Rajiva
authors.affiliation: Indian Institute of Public Health, Ahmedabad, Gujarat, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Dutta
authors.affiliation: Natural Resources Defense Council, New York, New York, United States of America.
authors.forename: Anjali
authors.initials: A
authors.lastname: Jaiswal
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Perry
authors.initials: P
authors.lastname: Sheffield
authors.affiliation: Columbia Mailman School of Public Health, New York, New York, United States of America; Natural Resources Defense Council, New York, New York, United States of America.
authors.forename: Kim
authors.initials: K
authors.lastname: Knowlton
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America; Department of Environmental Health, Emory University School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Hess
mesh_terms: D002423:Cause of Death; D005260:Female; D018882:Heat Stress Disorders / Q000453:epidemiology* / Q000401:mortality; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007194:India; D008297:Male; D009026:Mortality; D012621:Seasons