Inequality of chronic kidney disease burden attributable to heat waves and related hospital accessibility amid climate change in China: A modeling study

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Inequality of chronic kidney disease burden attributable to heat waves and related hospital accessibility amid climate change in China: A modeling study

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Co-author 1

Wanzhou Wang xjswangwanzhou@pku.edu.cn Peking University Health Science Center Institute of Medical Technology Beijing China - Peking University National Institute of Health Data Science Beijing China

Co-author 2

Fulin Wang wangfulin0103@163.com Peking University Health Science Center Institute of Medical Technology Beijing China - Peking University National Institute of Health Data Science Beijing China

Co-author 3

Xiao Zhang zhangxiaotiti@126.com Chinese Center for Disease Control and Prevention National Center for Chronic and Noncommunicable Diseases Control and Prevention Beijing China -

Co-author 4

Chao Yang yangchao@bjmu.edu.cn Peking University First Hospital Renal Division, Department of Medicine Beijing China * Peking University First Hospital Center for Digital Health and Artificial Intelligence Beijing China

Co-author 5

Limin Wang wanglimin@ncncd.chinacdc.cn Chinese Center for Disease Control and Prevention National Center for Chronic and Noncommunicable Diseases Control and Prevention Beijing China -

Co-author 6

Luxia Zhang zhanglx@bjmu.edu.cn Peking University First Hospital Renal Division, Department of Medicine Beijing China - Peking University First Hospital Center for Digital Health and Artificial Intelligence Beijing China

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

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Co-author 15

Introduction

Heat waves are increasingly recognized as an environmental determinant of chronic kidney disease (CKD). However, the CKD burden attributable to heat waves and associated healthcare inequalities, particularly under future climate change, remains insufficiently characterized.To address these research gaps, we aimed to provide systematic evidence on the burden of advanced (stages 4–5) CKD attributable to heat waves and the inequalities caused by hospital accessibility amid climate change in our study.

Methods

We conducted a nationwide 1-km grid–level analysis integrating the most recent nationally representative CKD prevalence data, climate projections, population estimates, and socioeconomic indicators. The analysis focused on stages 4–5 CKD, given its progressive nature and requirements for continuous medical treatment. Heat wave–attributable CKD burden was quantified as attributable cases (ACs), attributable fractions (AFs), and population attributable fractions (PAFs). Hospital accessibility was evaluated using AC-weighted driving times and accessibility scores, with inequality assessed via Gini indices and Lorenz curves. Projections for 2030–2090 were generated under multiple Shared Socioeconomic Pathways (SSPs).

Results

Nationally, in the current (2020), heat waves were responsible for 491,362 (227,772–694,191) stages 4–5 CKD cases (about 30.06% of all cases and 45.31 per 100,000 adults), disproportionately affecting rural areas (PAF: 47.08 per 100,000) and subtropical and tropical regions (PAF: 52.43 per 100,000). The average driving time to the nearest hospital for ACs was 15.8 (7.6–22.3) minutes, with rural areas showing significantly longer times (20.4 minutes) and lower accessibility. The national Gini index for hospital accessibility was 0.45, indicating significant inequality, which was more pronounced in rural areas (0.50), Eastern regions (0.49), and Western regions (0.46). Projections indicated increasing trends in PAFs under high-emission scenarios (e.g., SSP5-8.5 showing >2-fold increase in 2090), while high levels of hospital accessibility inequality could persist across all future climate scenarios.

Conclusion

Heat waves induce a substantial and spatially uneven burden of advanced CKD in China, compounded by significant inequalities in hospital accessibility. These inequalities are likely to persist under future climate change given current hospital accessibility settings.

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