The association of compound hot extreme with mortality risk and vulnerability assessment at fine-spatial scale.

The frequency and intensity of compound hot extremes will be likely to increase in the context of global warming. Epidemiological studies have demonstrated the adverse effect of simple hot extreme events on mortality, but little is known about the effects of compound hot extremes on mortality. Daily meteorological, demographic, and mortality data during 2011-2017 were collected from 160 streets in Guangzhou City, China. We used distributed lag non-linear model (DLNM) to analyze the associations of different hot extremes with mortality risk in each street. Street-specific associations were then combined using a meta-analysis approach. To assess the spatial distribution of vulnerability to compound hot extremes, vulnerable characteristics at street level were selected using random forest model, and then we calculated and mapped spatial vulnerability index (SVI) at each street in Guangzhou. At street level, compared with normal day, compound hot extreme significantly increased mortality risk (relative risk(RR)=1.43, 95%CI:1.28-1.59) with higher risk for female (RR=1.54 [1.35-1.76]) and the elderly(RR for aged 65-74=1.41 [1.14-1.74]; RR for ≥75years=1.63 [1.45-1.84]) than male (RR=1.32 [1.15-1.52]) and population <65 years (RR=1.01 [0.83-1.22]). Areas with high vulnerability were in the urban center and the edge of suburban. High proportion of population over 64 years old in urban center, and high proportions of outdoor workers and population with illiteracy in suburban areas were the determinants of spatial vulnerability. We found that compound hot extreme significantly increased mortality risk at street level, which is modified by socio-economic and demographic factors. Our findings help allocate resources targeting vulnerable areas at fine-spatial scale.°.