In China, most previous projections of heat-related mortality have been based on modeling studies using global climate models (GCMs), which can help to elucidate the risks of extreme heat events in a changing climate. However, spatiotemporal changes in the health effects of climate change considering specific regional characteristics remain poorly understood. We aimed to use credible climate and population projections to estimate future heatwave-attributable deaths under different emission scenarios and to explore the drivers underlying these patterns of changes. We derived climate data from a regional climate model driven by three CMIP5 GCM models and calculated future heatwaves in China under Representative Concentration Pathway (RCP) 2.6, RCP4.5, and RCP8.5. The future gridded population data were based on Shared Socioeconomic Pathway 2 assumption with different fertility rates. By applying climate zone-specific exposure-response functions to mortality during heatwave events, we projected the scale of heatwave-attributable deaths under each RCP scenario. We further analyzed the factors driving changes in heatwave-related deaths and main sources of uncertainty using a decomposition method. We compared differences in death burden under the 1.5°C target, which is closely related to achieving carbon neutrality by mid-century. The number of heatwave-related deaths will increase continuously to the mid-century even under RCP2.6 and RCP4.5 scenarios, and will continue increasing throughout the century under RCP8.5. There will be 20,303 deaths caused by heatwaves in 2090 under RCP2.6, 35,025 under RCP4.5, and 72,260 under RCP8.5, with half of all heatwave-related deaths in any scenario concentrated in east and central China. Climate effects are the main driver for the increase in attributable deaths in the near future till 2060, explaining 78% of the total change. Subsequent population decline cannot offset the losses caused by higher incidence of heatwaves and an aging population under RCP8.5. Although health loss under the 1.5°C warming scenario is 1.6-fold higher than the baseline period 1986–2005, limiting the temperature rise to 1.5°C can reduce the annual mortality burden in China by 3,534 deaths in 2090 compared with RCP2.6 scenarios. With accelerating climate change and population aging, the effects of future heatwaves on human health in China are likely to increase continuously even under a low emission scenario. Significant health benefits are expected if the optimistic 1.5°C goal is achieved, suggesting that carbon neutrality by mid-century is a critical target for China's sustainable development. Policymakers need to tighten climate mitigation policies tailored to local conditions while enhancing climate resilience technically and infrastructurally, especially for vulnerable elderly people. National Key R&D Program of China (2018YFA0606200), Wellcome Trust (209734/Z/17/Z), Natural Science Foundation of China (41790471), and Guangdong Major Project of Basic and Applied Basic Research (2020B0301030004).

Frequent heatwaves under global warming can increase the risk of preterm birth (PTB), which in turn will affect physical health and human potential over the life course. However, what remains unknown is the extent to which anthropogenic climate change has contributed to such burdens. We combine health impact and economic assessment methods to comprehensively evaluate the entire heatwave-related PTB burden in dimensions of health, human capital and economic costs. Here, we show that during 2010-2020, an average of 13,262 (95%CI 6,962-18,802) PTBs occurred annually due to heatwave exposure in China. In simulated scenarios, 25.8% (95%CI 17.1%-34.5%) of heatwave-related PTBs per year on average can be attributed to anthropogenic climate change, which further result in substantial human capital losses, estimated at over $1 billion costs. Our findings will provide additional impetus for introducing more stringent climate mitigation policies and also call for more sufficient adaptations to reduce heatwave detriments to newborn.

This study analyzes the change characteristics of compound extreme events (CEEs) of temperature and precipitation (including warm‐wet, warm‐dry, cold‐wet and cold‐dry) in China on interannual and interdecadal scales between 1901 and 2019. The results demonstrate a long‐term increasing trend and interdecadal oscillations in CEEs total frequency. However, the frequency of each type of CEEs changes in a different manner compared with total CEEs frequency. There are fewer CEEs but increasing warm‐dry during 1901–1950. The period 1951–1995 are characterized by frequent cold CEEs (cold‐wet and cold‐dry), cold‐wet are largely distributed in most areas except for northeast and coastal areas of China, while cold‐dry are distributed in most areas except for the northwest regions of China. There are frequent warm CEEs (warm‐wet and warm‐dry) and fewer cold CEEs during 1996–2019. Warm‐wet frequently occurs in the Tibetan Plateau and northwest China, and warm‐dry mainly concentrates in southwest and northern China during this period. The frequency of warm‐dry and cold‐wet were higher than that of warm‐wet and cold‐dry over the past 119 years, whereas warm‐wet increased fastest in the northwest region after 1996, consistent with the warming and wetting characteristics in the northwest region of China. Further study show that long‐term change and low frequency oscillations have the greatest impact on CEEs among different time scale factors. Furthermore, the temperature rise caused by climate change affects the interdecadal characteristics of CEEs in China through the changes of circulation fields such as East Asian trough and subtropical high and the configuration between them.