Heatwaves and Mortality: The Influence of Choice of Definition and Lag.

To investigate whether the reported additional effects of heatwaves on mortality are truly independent or instead reflect incomplete control for lagged temperature effects, and to assess whether this relationship varies by heatwave definition (e.g., minimum duration and intensity thresholds), as a potential explanation for heterogeneity in findings across the literature. We collected daily all-cause mortality records spanning 19 years (2000-2018) in Amman, Jordan. Heatwaves were identified using 20 definitions with varying temperature thresholds (percentile-based) and durations (2-5 consecutive days). Generalized Additive Models with penalized splines and Distributed Lag Non-linear Models were used to assess temperature-mortality associations and investigate how lag adjustment impacts the observed heatwave added effect. Without accounting for the lagged effects of temperature, heatwaves showed a significant additional effect on mortality in 7 out of 20 definitions. However, after properly controlling for these lagged effects, none of the heatwave definitions based on duration and threshold demonstrated a significant additional effect on mortality beyond what can be attributed to the cumulative (same day plus lagged) effect of daily temperature. The apparent added effect of heatwaves on mortality is largely explained by the cumulative impact of daily temperatures, suggesting that research and efforts might be more effective if focused on the cumulative effect of temperatures instead.