Abstract
Background
Numerous studies on the association between high temperatures and mortality identify the Mediterranean region as particularly vulnerable to the health effects of heat. Although there is research on social inequalities in this relationship, studies examining their temporal evolution remain scarce. Therefore, the main objective of this study is to analyse changes in social inequalities in the relationship between heat and mortality in Barcelona from 1994 to 2023.
Methods
Daily mortality from natural causes in Barcelona was examined, stratified by sex (women and men), age ((65–84 and ≥85 years), educational level (low and high), and subperiods (1994–2003, 2004–2013, 2014–2023). Exposure was measured using daily mean temperature from the Fabra Observatory. A time-series study using quasi-Poisson regression and distributed lag non-linear models (DLNM) estimated the association and impact of heat in each group. Relative and absolute inequality metrics were calculated to assess their evolution over time.
Results
A clear association between heat and mortality was observed across all groups. Women, individuals aged ≥85 years, and those with lower educational levels were the most affected. Both risk and impact decreased during the second sub‑period and increased again in the third, although without reaching initial levels. Inequalities have persisted over time, with increasing disparities among women according to educational level.
Conclusions
Stratification and the use of different metrics allowed for the identification of the most affected groups, which are consistent with existing literature. Results indicate a recent rebound in heat‑related impacts and the persistence of social inequalities, highlighting the need to incorporate socioeconomic determinants into public health surveillance to design more equitable and effective climate‑change adaptation policies.
Speakers/Panellists
Francesca De’Donato
Lazio Regional Health Service - ASL Roma 1, Rome, Italy
Ana Diez-Roux
Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, USA