Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.2.4.2 Injuries Arising from Extreme Weather Events Other than Heat and Cold ====

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Injuries comprise a substantial portion of the global burden of disease. In 2019, injuries comprised 9.82% of total global DALYs and 7.61% of deaths (Vos et al., 2020). The causal pathways for many injuries, particularly those from heat and extreme weather events, flooding and fires, exhibit clear climate sensitivity ( [[#Roberts--2007|Roberts and Arnold, 2007]] ; [[#Roberts--2005|Roberts and Hillman, 2005]] ), as do some injuries occurring in occupational settings ( [[#Marinaccio--2019|Marinaccio et al., 2019]] ; [[#Sheng--2018|Sheng et al., 2018]] ), but a comprehensive assessment of climate sensitivity in injury causal pathways has not been done. Certain groups, including Indigenous Peoples, children and the elderly ( [[#Ahmed--2020|Ahmed et al., 2020]] ) are at greater risk for a wide range of injuries. Extreme events impose substantial disease burden directly as a result of traumatic injuries, drowning and burns and large mental health burdens associated with displacement ( [[#Fullilove--1996|Fullilove, 1996]] ), depression and post-traumatic stress disorder (PTSD), but the overall injury burden associated with extreme weather is not known. It is known that the Asia-Pacific region has experienced the highest relative burden of injuries from extreme weather in recent decades ( [[#Hashim--2016|Hashim and Hashim, 2016]] ).

Extreme weather imposes a substantial morbidity and mortality burden that is quite variable by location and hazard. The proportion of this burden related specifically to injuries is not established. From 1998 to 2017 there were 526,000 deaths from 11,500 extreme weather events, and the average annual attributable all-cause mortality incidence in the ten most affected countries was 3.5 per 100,000 population ( [[#Eckstein--2017|Eckstein et al., 2017]] ). Rates can be much higher; mortality incidence in Puerto Rico and Dominica from extreme weather were 90.2 and 43.7 per 100,000 population in 2017, respectively ( [[#Eckstein--2017|Eckstein et al., 2017]] ). Not all of these deaths are from injuries, and the proportion of mortality and morbidity associated with injuries varies by location and hazard. One review found that one-year post-event prevalence rates for injuries associated with extreme events (floods, droughts, heatwaves and storms) in developing countries ranged from 1.4% to 37.9% ( [[#Rataj--2016|Rataj et al., 2016]] ). Other literature has documented an increase in the risk of motor vehicle accidents in association with extreme precipitation ( [[#Liu--2017|Liu et al., 2017]] ; [[#Stevens--2019|Stevens et al., 2019]] ), temperature ( [[#Leard--2019|Leard and Roth, 2019]] ) and sandstorms ( [[#Islam--2019|Islam et al., 2019]] ) and an increased risk of traumatic occupational injuries associated with temperature extremes, particularly extreme heat, likely from fatigue and decreased psychomotor performance ( [[#Varghese--2019|Varghese et al., 2019]] ).

There is clear evidence of climate sensitivity for multiple injuries from floods, fires and storms, but there is a need for additional evidence regarding the current injury burden attributable to climate change. It is ''as likely as not'' that climate change has increased the current burden of disease from injuries related to extreme weather, particularly in low-income settings ''(low confidence)'' . Approximately 120 million people are exposed to coastal flooding annually ( [[#Nicholls--2007|Nicholls et al., 2007]] ), causing an estimated 12,000 deaths ( [[#Shultz--2005|Shultz et al., 2005]] ), and there is significant concern for worsening flooding associated with climate change ( [[#Shultz--2018a|Shultz et al., 2018a]] ; [[#Shultz--2018b|Shultz et al., 2018b]] ; [[#Woodward--2018|Woodward and Samet, 2018]] ) but very limited quantification of attributable burden. A range of adverse health outcomes has been identified in a study of fires in sub-zero temperatures that are thought to be increasing in frequency due to climate change ( [[#Metallinou--2017|Metallinou and Log, 2017]] ).

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