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In general, there are few studies that analyse the impact of low temperatures on mortality, and even fewer that extend this analysis to specific causes of mortality. This study had a twofold aim: Firstly, to analyse the trend in natural-, circulatory- and respiratory-cause mortality associated with cold waves in Castile-La Mancha (Spain) across a period of analysis of 34 years, which would confer an important degree of temporal representativeness on the results obtained; and secondly, to ascertain whether this impact had decreased over the years. Time series analysis using multivariate ARIMA models with data on daily natural-, circulatory- and respiratory-cause mortality in Castile-La Mancha. The independent variables were minimum daily temperature, mean daily pressure and mean daily relative humidity. We controlled for seasonalities and trend of the series, as well as influenza epidemics, cold-wave duration and chronological number in any given year. Data were stratified in three ten-year stages, i.e., 1975-1985, 1986-1996 and 1997-2008. The mortality trigger temperature was set at a minimum daily temperature of −2 °C, corresponding to the 4th ‰ of the minimum temperature series for the winter months considered. The impact on daily natural-cause mortality for each degree that the minimum daily temperature was below −2 °C was: 10.4 % (95 % CI 9.6-11.2) in the first decade; 11.9 % (95 % CI 11.0-12.8) in the second decade; and fell to 1.6 % (95 % CI 0.9-2.3) in the third. This same pattern was observed for circulatory- and respiratory-cause mortality, with the effect of cold being greater for respiratory causes. Socio-economic factors -both of adaptation and demographic- could account for this sharp decrease in mortality associated with low temperatures. These results question climate models which predict the effects of cold over long-term time horizons, while maintaining the risk attributable to low temperatures constant. Studies similar to ours should be undertaken in other regions to confirm whether it is solely local characteristics that explain this pattern or, on the contrary, whether the pattern is generalised. [ABSTRACT FROM AUTHOR]