Building resilience to climate change: Pilot evaluation of the impact of India’s first heat action plan on all-cause mortality

Background. Ahmedabad implemented South Asia’s first heat action plan (HAP) after a 2010 heatwave. This study evaluates the HAP’s impact on all-cause mortality in 2014–2015 relative to a 2007–2010 baseline. Methods. We analyzed daily maximum temperature (T_max)-mortality relationships before and after HAP. We estimated rate ratios (RRs) for daily mortality using distributed lag nonlinear models and mortality incidence rates (IRs) for HAP warning days, comparing pre- and post-HAP periods, and calculated incidence rate ratios (IRRs). We estimated the number of deaths avoided after HAP implementation using pre- and post-HAP IRs. Results. The maximum pre-HAP RR was 2.34 (95%CI 1.98–2.76) at 47^°C (lag 0), and the maximum post-HAP RR was 1.25 (1.02–1.53) estimated at 47^°C (lag 0). Post-to-pre-HAP nonlagged mortality IRR for T_max over 40^°C was 0.95 (0.73–1.22) and 0.73 (0.29–1.81) for T_max over 45^°C. An estimated 1,190 (95%CI 162–2,218) average annualized deaths were avoided in the post-HAP period. Conclusion. Extreme heat and HAP warnings after implementation were associated with decreased summertime all-cause mortality rates, with largest declines at highest temperatures. Ahmedabad’s plan can serve as a guide for other cities attempting to increase resilience to extreme heat.