Exploring 130 years of temperature-related mortality in the city of Madrid.

The relationship between ambient temperatures and health outcomes has been extensively studied, yet long-term analyses of mortality responses to extreme temperatures, particularly in the Mediterranean region, remain scarce. This study leverages daily all-cause mortality and air temperature data in the city of Madrid from 1890 to 2019 to examine adaptation patterns to extreme and moderate heat and cold. Using a distributed lag non-linear modeling framework, we explored temperature-mortality relationships and estimated decade-specific adaptation metrics. Results indicate a general reduction in temperature-attributable mortality, primarily due to decreased cold-related risks across all population groups. While moderate heat impact declined over time, extreme heat effects remained stable, with a slight increase towards the study’s end. Our findings highlight the dual impact of climate change, i.e. reducing cold-related mortality while stabilizing heat-related risks, which emphasizes the complex interplay of climate change and health outcomes and offers new insights into adaptation dynamics using long-term temperature-mortality time series.