{"id":"https://openalex.org/W7225825497","doi":"https://doi.org/10.21203/rs.3.rs-11384191/v1","title":"Heat Index Exposure and Cardiovascular Disease Burden in India: Population-Attributable Risk and Economic Implications","display_name":"Heat Index Exposure and Cardiovascular Disease Burden in India: Population-Attributable Risk and Economic Implications","publication_year":2026,"publication_date":"2026-11-11","ids":{"openalex":"https://openalex.org/W7225825497","doi":"https://doi.org/10.21203/rs.3.rs-11384191/v1"},"language":"en","primary_location":{"id":"doi:10.21203/rs.3.rs-11384191/v1","doi":"https://doi.org/10.21203/rs.3.rs-11384191/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11384191/v1","pdf_url":null,"source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.21203/rs.3.rs-11384191/v1","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5087584750","display_name":"Soundarya Soundararajan","orcid":"https://orcid.org/0000-0003-0383-8389","observed_orcids":["https://orcid.org/0000-0003-0383-8389"]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210105310","display_name":"National Institute of Occupational Health","ror":"https://ror.org/01praqa56","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Soundarya Soundararajan","raw_affiliation_strings":["ICMR-National Institute of Occupational Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Occupational Health","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056326301","display_name":"Bhavani Shankara Bagepally","orcid":"https://orcid.org/0000-0003-0856-767X","observed_orcids":["https://orcid.org/0000-0003-0856-767X"]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210100069","display_name":"National Institute of Epidemiology","ror":"https://ror.org/011471042","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210100069"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Bhavani Shankara Bagepally","raw_affiliation_strings":["ICMR-National Institute of Epidemiology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Epidemiology","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210100069"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5116319112","display_name":"Jhalak Dhingra","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210105310","display_name":"National Institute of Occupational Health","ror":"https://ror.org/01praqa56","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Jhalak Dhingra","raw_affiliation_strings":["ICMR-National Institute of Occupational Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Occupational Health","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161457410","display_name":"Nimitha Mohan","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210100069","display_name":"National Institute of Epidemiology","ror":"https://ror.org/011471042","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210100069"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Nimitha Mohan","raw_affiliation_strings":["ICMR-National Institute of Epidemiology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Epidemiology","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210100069"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019159657","display_name":"Bhavesh Modi","orcid":"https://orcid.org/0000-0003-0004-6693","observed_orcids":["https://orcid.org/0000-0003-0004-6693"]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210105310","display_name":"National Institute of Occupational Health","ror":"https://ror.org/01praqa56","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Bhavesh Modi","raw_affiliation_strings":["ICMR-National Institute of Occupational Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Occupational Health","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5047541472","display_name":"Rakesh Balachandar","orcid":"https://orcid.org/0000-0002-9940-4878","observed_orcids":["https://orcid.org/0000-0002-9940-4878"]},"institutions":[{"id":"https://openalex.org/I37048141","display_name":"Indian Council of Medical Research","ror":"https://ror.org/0492wrx28","country_code":"IN","type":"government","lineage":["https://openalex.org/I37048141"]},{"id":"https://openalex.org/I4210105310","display_name":"National Institute of Occupational Health","ror":"https://ror.org/01praqa56","country_code":"IN","type":"facility","lineage":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Rakesh Balachandar","raw_affiliation_strings":["ICMR-National Institute of Occupational Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"ICMR-National Institute of Occupational Health","institution_ids":["https://openalex.org/I37048141","https://openalex.org/I4210105310"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11244","display_name":"Climate Change and Health Impacts","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T11244","display_name":"Climate Change and Health Impacts","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10190","display_name":"Air Quality and Health Impacts","score":0.0010000000474974513,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T11109","display_name":"Thermoregulation and physiological responses","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C122048520","wikidata":"https://www.wikidata.org/wiki/Q2913954","display_name":"Percentile","level":2,"score":0.6920999884605408},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6843000054359436},{"id":"https://openalex.org/C2780664029","wikidata":"https://www.wikidata.org/wiki/Q5282120","display_name":"Disease burden","level":3,"score":0.6244000196456909},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.5275999903678894},{"id":"https://openalex.org/C16851059","wikidata":"https://www.wikidata.org/wiki/Q182467","display_name":"Attributable risk","level":3,"score":0.5239999890327454},{"id":"https://openalex.org/C3020448403","wikidata":"https://www.wikidata.org/wiki/Q5282120","display_name":"Burden of disease","level":3,"score":0.511900007724762},{"id":"https://openalex.org/C94919774","wikidata":"https://www.wikidata.org/wiki/Q1137675","display_name":"Crore","level":3,"score":0.46779999136924744},{"id":"https://openalex.org/C188897","wikidata":"https://www.wikidata.org/wiki/Q5333508","display_name":"Economic impact analysis","level":2,"score":0.44679999351501465},{"id":"https://openalex.org/C2778049256","wikidata":"https://www.wikidata.org/wiki/Q55627","display_name":"Disability-adjusted life year","level":4,"score":0.36419999599456787},{"id":"https://openalex.org/C96250715","wikidata":"https://www.wikidata.org/wiki/Q965330","display_name":"Estimation","level":2,"score":0.35659998655319214},{"id":"https://openalex.org/C64332521","wikidata":"https://www.wikidata.org/wiki/Q614165","display_name":"Quality-adjusted life year","level":3,"score":0.33340001106262207},{"id":"https://openalex.org/C2777382242","wikidata":"https://www.wikidata.org/wiki/Q6017816","display_name":"Index (typography)","level":2,"score":0.3199000060558319},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.3010999858379364},{"id":"https://openalex.org/C27548731","wikidata":"https://www.wikidata.org/wiki/Q88272","display_name":"Investment (military)","level":3,"score":0.2980000078678131},{"id":"https://openalex.org/C24338571","wikidata":"https://www.wikidata.org/wiki/Q2566298","display_name":"Autoregressive integrated moving average","level":3,"score":0.2815999984741211},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.2750000059604645},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.27149999141693115},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.26759999990463257},{"id":"https://openalex.org/C2777615720","wikidata":"https://www.wikidata.org/wiki/Q11888847","display_name":"Prioritization","level":2,"score":0.26579999923706055}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.21203/rs.3.rs-11384191/v1","doi":"https://doi.org/10.21203/rs.3.rs-11384191/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11384191/v1","pdf_url":null,"source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.21203/rs.3.rs-11384191/v1","doi":"https://doi.org/10.21203/rs.3.rs-11384191/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11384191/v1","pdf_url":null,"source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":19,"referenced_works":["https://openalex.org/W2055002961","https://openalex.org/W2145152860","https://openalex.org/W2157010400","https://openalex.org/W2162775913","https://openalex.org/W2765130422","https://openalex.org/W2770287703","https://openalex.org/W2799349899","https://openalex.org/W2898634854","https://openalex.org/W2898656233","https://openalex.org/W3025949386","https://openalex.org/W3171801815","https://openalex.org/W4206384008","https://openalex.org/W4280490775","https://openalex.org/W4282823493","https://openalex.org/W4284900201","https://openalex.org/W4294983437","https://openalex.org/W4396595916","https://openalex.org/W4405111857","https://openalex.org/W4410979787"],"related_works":[],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Climate":[2],"change":[3,59],"is":[4,204],"intensifying":[5],"heat":[6],"exposure":[7,23,203],"in":[8,24,60,66,124,141,150,167,233],"South":[9],"Asia,":[10],"yet":[11],"the":[12,57,87,94,125,155,184,228],"population-level":[13],"cardiovascular":[14],"disease":[15],"(CVD)":[16],"burden":[17,62,99,172,187,213],"attributable":[18,104,165],"to":[19,111,162,216],"Heat":[20],"Index":[21],"(HI)":[22],"India":[25],"remains":[26],"unquantified.":[27],"Methods":[28],"We":[29],"analyzed":[30],"state-level":[31,224],"panel":[32,53],"data":[33],"(29":[34],"states,":[35],"2011\u20132021)":[36],"linking":[37],"ERA5-derived":[38],"HI":[39,92,130,202],"metrics":[40],"with":[41,86,133,206],"Global":[42],"Burden":[43],"of":[44,90,128,173,210,230],"Disease":[45],"CVD":[46,61,142,212],"outcomes":[47],"(DALYs,":[48],"YLL,":[49],"YLD).":[50],"Log-linear":[51],"fixed-effects":[52],"regression":[54],"models":[55],"estimated":[56,101],"percent":[58],"per":[63],"unit":[64],"increase":[65,123,140,149],"HI,":[67],"adjusting":[68],"for":[69],"state":[70],"and":[71,109,115,144,169,219],"year":[72],"fixed":[73],"effects.":[74],"The":[75,152],"population-attributable":[76],"fraction":[77,209],"(PAF)":[78],"was":[79,100,131,159,188],"calculated":[80],"using":[81,113],"a":[82,134,145,197,207,217],"model-based":[83],"counterfactual":[84],"approach":[85],"80th":[88,156],"percentile":[89,127,157],"observed":[91],"as":[93],"reference":[95],"threshold.":[96],"State-specific":[97],"economic":[98,171,186,221],"by":[102,106],"multiplying":[103],"DALYs":[105,143,166],"cost-per-DALY":[107],"values":[108],"projected":[110,185],"2030":[112],"ARIMA":[114],"3%":[116],"annual":[117],"cost":[118],"growth.":[119],"Results":[120],"A":[121],"one-unit":[122],"97.5th":[126],"average":[129],"associated":[132,205],"1.62%":[135],"(95%":[136],"CI:":[137],"0.67%,":[138],"2.57%)":[139],"1.7%":[146],"(0.7%,":[147],"2.7%)":[148],"YLL.":[151],"PAF":[153],"at":[154],"threshold":[158],"0.28%,":[160],"corresponding":[161],"approximately":[163,174,189],"206,000":[164],"2021":[168],"an":[170],"INR":[175,190],"1,485":[176],"Crore":[177,192],"(~":[178,193],"USD":[179,194],"199":[180],"million).":[181],"By":[182],"2030,":[183],"2,174":[191],"292":[195],"million),":[196],"46%":[198],"increase.":[199],"Conclusions":[200],"Extreme":[201],"measurable":[208],"India\u2019s":[211],"that":[214],"translates":[215],"substantial":[218],"growing":[220],"cost.":[222],"These":[223],"estimates":[225],"can":[226],"inform":[227],"prioritization":[229],"heat\u2013health":[231],"interventions":[232],"India.":[234]},"counts_by_year":[],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-11-12T00:00:00"}