The potential burden from urbanisation on heat-related mortality in Sao Paulo, Brazil

Heatwave events are associated with increased hospital admissions and mortality rates worldwide. Heat exposure is often exacerbated by the Urban Heat Island (UHI) effect, especially in large cities. However, an accurate quantification of the additional burden related to heat from urbanisation is understudied in Latin American cities. Therefore, we used advanced meteorological modelling to simulate 2 m air temperature at 1 km spatial resolution across Sao Paulo, estimating UHI intensity attributing of all-cause mortality to heat and UHI during the 2014 heatwave. The Local Climate Zone classification system provided input land use parameters. Our model was validated against 31 weather stations and bias-corrected using linear regression. We calculated heat-related all-cause mortality, stratified by age, using the modelled temperature data, estimating 394 heat-related deaths. A counterfactual experiment, replacing urban areas with natural land, quantified the additional UHI burden. We found that the UHI may contribute to 69-70% of heat-related mortality (modelled temperature scenario). This work motivates the use of appropriate urban climate data, including careful model validation and bias correction, when assessing heat exposure and health risk assessment. It also highlights the health impacts from heatwaves in cities such as Sao Paulo, which are likely to increase due to climate change.