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 ( < 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 ( < 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.