The extreme heat caused illness, death, crop losses, and strained energy and health care systems, according to the analysis from World Weather Attribution, Climate Central and the Red Cross.

“Although floods and cyclones often dominate headlines, heat is arguably the deadliest extreme event,” the report said. Many heat-related deaths are unreported or are mislabeled by other conditions like heart disease or kidney failure.

Caribbean islands were among the hardest hit by additional extreme heat days. Puerto Rico, a territory of the United States, endured 161 days of extreme heat. Without climate change, only 48 would have occurred.