{"doi":"10.1016/j.joclim.2025.100484","title":"Too hot and too humid in the Caribbean: Impacts of extreme heat events and non-accidental mortality in the tropical island of Puerto Rico (2015-2020)","abstract":"Background: The complex interactions between heat and public health in tropical environments are not well understood, limiting the integrated understanding of heat-related impacts on the sustainability and resilience of the affected populations. Objectives: To provide evidence on the impact of heat stress on mortality in Puerto Rico by means of indices that are based on physiologically relevant environmental factors. Methods: Daily data on non-accidental mortality for the period of 2015-2020 were obtained from the Puerto Rico Department of Health. We obtained 2 meter ambient air temperature data across the whole geographical extent of Puerto Rico and for the 2015-2020 period at an hourly step from the ERA5 climate reanalysis dataset. We employed two indices derived from thermo-physiological models: the Universal Thermal Climate Index (UTCI) and the Heat Index (HI). Poisson regression models were fitted to explain the total number of deaths as a function of UTCI and HI while adjusting for sex and age. Results: We observed an increase in overall non-accidental mortality in the days categorized as the highest tertile of both HI (IRR: 1.23, 95% CI: 1.21; 1.25) and UTCI (IRR:1.47, 95% CI: 1.44; 1.49) in the adjusted model. Myocardial infarction, ischemic heart disease, heart failure, and cerebrovascular disease were some of the primary causes of death. Conclusion: Results will provide local decision-makers with sufficient evidence on heat stress impacts and valuable information on vulnerability that can be translated into heat adaptation strategies in Puerto Rico.","journal":"The Journal of Climate Change and Health","year":2025,"id":526456,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9536,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":217958,"name":"Claudia Di Napoli","orcid":"0000-0002-4901-3641","position":1,"is_corresponding":false},{"id":424136,"name":"Sona Rivas‐Tumanyan","orcid":"0000-0002-3773-7028","position":2,"is_corresponding":false},{"id":579314,"name":"Naydi Pérez-Ríos","orcid":"0000-0003-2878-5308","position":3,"is_corresponding":false},{"id":1402573,"name":"Lorena González Sepúlveda","orcid":null,"position":4,"is_corresponding":false},{"id":1401997,"name":"Ernesto Rodríguez Camino","orcid":"0000-0002-1565-2373","position":5,"is_corresponding":false},{"id":1402574,"name":"Ernesto Morales","orcid":null,"position":6,"is_corresponding":false},{"id":1402575,"name":"Odalys Martínez","orcid":null,"position":7,"is_corresponding":false},{"id":1401998,"name":"Laura T. Cabrera-Rivera","orcid":"0000-0001-9067-1200","position":8,"is_corresponding":false},{"id":1402576,"name":"Mónica V. Sánchez-Sepúlveda","orcid":null,"position":9,"is_corresponding":false},{"id":1402577,"name":"Liza Milán","orcid":null,"position":10,"is_corresponding":false},{"id":1375570,"name":"Pablo Méndez‐Lázaro","orcid":"0000-0002-3059-3295","position":0,"is_corresponding":true}],"reference_count":70,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:50:30.402772Z","pmid":"41235024","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}