Territory Differences in Adaptation to Heat among Persons Aged 65 Years and Over in Spain (1983–2018)

Climate change is currently regarded as the greatest global threat to human health, and its health-related consequences take different forms according to age, sex, socioeconomic level, and type of territory. The aim of this study is to ascertain the differences in vulnerability and the heat-adaptation process through the minimum mortality temperature (MMT) among the Spanish population aged ≥65 years by territorial classification. A retrospective, longitudinal, ecological time-series study, using provincial data on daily mortality and maximum daily temperature across the period 1983–2018, was performed, differentiating between urban and nonurban populations. The MMTs in the study period were higher for the ≥65-year age group in urban provinces, with a mean value of 29.6 °C (95%CI 29.2–30.0) versus 28.1 °C (95%CI 27.7–28.5) in nonurban provinces. This difference was statistically significant (p < 0.05). In terms of adaptation levels, higher average values were obtained for nonurban areas, with values of 0.12 (95%CI −0.13–0.37), than for urban areas, with values of 0.09 (95%CI −0.27–0.45), though this difference was not statistically significant (p < 0.05). These findings may contribute to better planning by making it possible to implement more specific public health prevention plans. Lastly, they highlight the need to conduct studies on heat-adaptation processes, taking into account various differential factors, such as age and territory.This research was funded by the Carlos III Institute of Health, grants for the ENPY 107/18, ENPY 376/18, and ENPY 470/19 projects under dossier no. ENPY 470/19, and support received from the Biodiversity Foundation, Ministry for Ecological Transition and Demographic Challenge