Modeling the Future Incidence of Preeclampsia under Climate Change and Population Growth Scenarios

Preeclampsia is a dangerous pregnancy disorder, with evidence suggesting that high ambient temperatures may increase its risk, making future incidence projections crucial for health planning. While temperature-related projections for all-cause mortality exist, disease-specific projections, especially for pregnancy complications, are limited due to data and methodological challenges. Vicedo-Cabrera et al. (2019) pioneered a time-series approach to project health impacts using the attributable fraction (AF) of cases due to climate change. We adjusted this method for preeclampsia, whose risk involves long-term exposures, with delivery as a competing event. We based our analysis on the exposure-response relationship estimated in our previous study in southern Israel using cause-specific hazard and distributed lag nonlinear models. In the current study, we modeled several demographic and climate scenarios in the region for 2020-2039 and 2040-2059. Scenario-specific AFs were calculated by comparing cumulative preeclampsia incidence with and without corresponding climate change. Finally, annual cases were estimated by applying climate scenario-specific AFs to cases projected under each demographic scenario. Our models show that climate change alone may increase preeclampsia by 3.2% to 4.3% in 2040-2059 relative to 2000-2019. Fertility trends are modeled to have a larger impact, with a 30% increase in cases by 2020-2039 under a low-fertility scenario. Extreme high-fertility and climate scenarios could result in a 2.3-fold rise in incidence, from 486 cases annually in 2000-2019 to 1,118 by 2040-2059.