Hospitalization risks associated with floods in a multi-country study

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Yang, Zhengyu
Huang, Wenzhong
McKenzie, Joanne E
Xu, Rongbin
Yu, Pei
Wu, Yao
Liu, Yanming
Wen, Bo
Zhang, Yiwen
Yu, Wenhua
Ye, Tingting
Zhang, Yuxi
Ju, Ke
Hales, Simon
Coelho, Micheline de Sousa Zanotti Stagliorio
et al.
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2025
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Abstract

Floods of unprecedented intensity and frequency have been observed. However, evidence regarding the impacts of floods on hospitalization remains limited. Here we collected daily hospitalization counts during 2000–2019 from 747 communities in Australia, Brazil, Canada, Chile, New Zealand, Taiwan, Thailand and Vietnam. For each community, flooded days were defined as days from the start dates to the end dates of flood events. Lag–response associations between flooded day and daily hospitalization risks were estimated for each community using a quasi-Poisson regression model with a distributed lag nonlinear function. The community-specific estimates were then pooled using a random-effects meta-analysis. Based on the pooled estimates, attributable fractions of hospitalizations due to floods were calculated. We found that hospitalization risks increased and persisted for up to 210 days after flood exposure, with the overall relative risks being 1.26 (95% confidence interval 1.15–1.38) for all causes, 1.35 (1.21–1.50) for cardiovascular diseases, 1.30 (1.13–1.49) for respiratory diseases, 1.26 (1.10–1.44) for infectious diseases, 1.30 (1.17–1.45) for digestive diseases, 1.11 (0.98–1.25) for mental disorders, 1.61 (1.39–1.86) for diabetes, 1.35 (1.21–1.50) for injury, 1.34 (1.21–1.48) for cancer, 1.34 (1.20–1.50) for nervous system disorders and 1.40 (1.22–1.60) for renal diseases. The associations were modified by climate types, flood severity, age, population density and socioeconomic status. Flood exposure contributed to hospitalizations by up to 0.27% from all causes. This study revealed that flood exposure was associated with increased all-cause and ten cause-specific hospitalization risks within up to 210 days after exposure.

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Nature Water

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3

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© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Yang, Z; Huang, W; McKenzie, JE; Xu, R; Yu, P; Wu, Y; Liu, Y; Wen, B; Zhang, Y; Yu, W; Ye, T; Zhang, Y; Ju, K; Hales, S; Coelho, MDSZS; et al., Hospitalization risks associated with floods in a multi-country study, Nature Water, 2025, 3, 561-570

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