Effects of the urban landscape on heatwave-mortality associations in Hong Kong: comparison of different heatwave definitions

Despite increased attention given to potential modifiers of temperature-mortality associations, evidence for variations between different urban landscape characteristics remains limited. It is in this context that in this paper effect modifications of multiple urban landscape characteristics are explored under different heatwave definitions for different age groups and gender in Hong Kong, China. Daily meteorological data and heatwave-related mortality counts from 2008 to 2017 were collected from the Hong Kong Census and Statistics Department, China. A case-only design was adopted, combined with logistic regression models to examine the modification effects of five urban landscape characteristics under six heatwave definitions. Stratified analyses were conducted to investigate age- and gender-specific effect modifications. It is found that individuals living in greener areas experienced lower levels of mortality during or immediately after heatwaves. In contrast, a higher building density and nighttime land surface temperature (LST) were associated with a higher heatwave-related mortality risk. Pronounced effect modifications of these urban landscape characteristics were observed under hotter and longer heatwaves, and in older adults (age & GT; 65 years) and males. The findings provide a scientific basis for policymakers and practitioners when considering measures for coping with hotter, longer, and more frequent heatwaves in the context of global climate change.