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Although the short-term heat effects are well-established, longer-term effects, beyond those, have recently received attention, in the context of climate change. Our study aims to investigate the potential effects of long-term exposure to non-optimal warm period temperatures on all-cause mortality in four large regions in the UK, Norway, Italy, and Greece. Daily all-cause mortality counts from 1996 to 2018 for four European NUTS-2 regions including 52-662 small areas were collected and associated with spatiotemporal temperature estimates. A NUTS-2 region-specific mixed quasi-Poisson over-dispersed model, with a random intercept per small area within NUTS-2 regions, was applied to investigate the association between long-term temperature exposure and mortality during the warm period (May to September), adjusting for short-term temperature, seasonality, long-term trends, and small-area population characteristics. As long-term temperature exposure indices per small area, we considered: 1) the warm period annual average temperature, 2) the annual standard deviation (SD) of warm period temperature, and 3) the coefficient of variation of warm period temperature (CV). We found consistent results following short-term temperature exposure on mortality, with higher effects in southern areas. Results on the shape of the long-term association between average temperature and mortality differed by country, while the different temperature metrics produced inconsistent findings. Increased mortality was associated with increased annual warm season temperature, lower SD and increased CV in Greece, with higher SD and decreased CV in Italy and with decreased annual temperature and CV in Norway. Effects in the UK did not reach the nominal level of statistical significance. Although our study implies an impact on mortality resulting from longer-term temperature exposure, its direction varied across areas and on the temperature metric used. Further research is warranted, applying non-ecological study designs and covering various geographical areas to capture the impact of individual and area-specific characteristics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Socioeconomic conditions remain an important factor in determining health outcomes in Northern Europe. In this commentary, we argue for evidence-based temperature-related climate adaptation policies in Northern Europe that account for disparities in socioeconomic conditions and aim at universal health coverage. We highlight the role of spatial and occupational disparities in urban areas that can be important factors in increased physical and mental health impacts related to heat and cold. We further highlight how these factors interplay with exposure to air pollution and access to green areas and worsen health conditions. Adaptation to changing climatic conditions requires both physiological acclimatization and behavioral adaptation, both of which are difficult to assess for socioeconomically deprived communities. We argue for more equitable climate adaptation strategies that include i) better integration of health in climate change adaptation plans; ii) building climate resilient communities, and iii) integrated surveillance and health systems. These actions could be vital in spearheading research in new cross-cutting areas like climate change, migration, and health., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Previous health impact assessments of temperature-related mortality in Europe indicated that the mortality burden attributable to cold is much larger than for heat. Questions remain as to whether climate change can result in a net decrease in temperature-related mortality. In this study, we estimated how climate change could affect future heat-related and cold-related mortality in 854 European urban areas, under several climate, demographic and adaptation scenarios. We showed that, with no adaptation to heat, the increase in heat-related deaths consistently exceeds any decrease in cold-related deaths across all considered scenarios in Europe. Under the lowest mitigation and adaptation scenario (SSP3-7.0), we estimate a net death burden due to climate change increasing by 49.9% and cumulating 2,345,410 (95% confidence interval = 327,603 to 4,775,853) climate change-related deaths between 2015 and 2099. This net effect would remain positive even under high adaptation scenarios, whereby a risk attenuation of 50% is still insufficient to reverse the trend under SSP3-7.0. Regional differences suggest a slight net decrease of death rates in Northern European countries but high vulnerability of the Mediterranean region and Eastern Europe areas. Unless strong mitigation and adaptation measures are implemented, most European cities should experience an increase of their temperature-related mortality burden., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)