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Background: In line with WHO guidelines for the implementation of public health prevention plans targeted at the impacts of high temperatures, a heat wave definition temperature (Tthreshold) was calculated for 182 so-called "isoclimatic zones" (IZ) in Spain. As the dependent variable for determining this Tthreshold, we analysed daily all-cause mortality data (ICD-10: A00-R99) for each IZ across the period 2009–2018. The independent variable used was the mean value of the maximum daily temperature of the summer months recorded at meteorological observatories in each IZ. We used Box–Jenkins models to ascertain mortality anomalies, and scatterplots to link these anomalies to the temperatures at which they occurred, thereby determining the Tthreshold for each IZ. We then calculated how many heat waves had occurred in each IZ, as well as their intensity, and analysed their time trend over this period. Results: The results showed that in 52.5% of the IZ, the percentile of the maximum temperatures series of the summer months to which Tthreshold corresponded was below the 95th percentile of the meteorological heat wave definition in Spain: indeed, it only coincided in 30.7% of cases. The geographical distribution of these percentiles displayed great heterogeneity as a consequence of the local factors that influence the temperature–mortality relationship. The trend in the number of heat waves analysed indicated an overall increase in Spain at a rate of 3.9 heat waves per decade, and a similar rise in mean annual intensity of 9.5 °C/decade. These time-trend values were higher than those yielded by analysing the trend in meteorological heat waves based on the 95th percentile. Conclusions: The results obtained in this study indicate the need to use a heat wave definition based on epidemiological temperature–mortality studies, rather than on values based on meteorological percentiles. This could be minimising estimated health impacts in analyses of future impacts attributable to heat. [ABSTRACT FROM AUTHOR]

In Spain the average temperature has increased by 1.7 °C since pre-industrial times. There has been an increase in heat waves both in terms of frequency and intensity, with a clear impact in terms of population health. The effect of heat waves on daily mortality presents important territorial differences. Gender also affects these impacts, as a determinant that conditions social inequalities in health. There is evidence that women may be more susceptible to extreme heat than men, although there are relatively few studies that analyze differences in the vulnerability and adaptation to heat by sex. This could be related to physiological causes. On the other hand, one of the indicators used to measure vulnerability to heat in a population and its adaptation is the minimum mortality temperature (MMT) and its temporal evolution. The aim of this study was to analyze the values of MMT in men and women and its temporal evolution during the 1983-2018 period in Spain's provinces. An ecological, longitudinal retrospective study was carried out of time series data, based on maximum daily temperature and daily mortality data corresponding to the study period. Using cubic and quadratic fits between daily mortality rates and the temperature, the minimum values of these functions were determined, which allowed for determining MMT values. Furthermore, we used an improved methodology that provided for the estimation of missing MMT values when polynomial fits were inexistent. This analysis was carried out for each year. Later, based on the annual values of MMT, a linear fit was carried out to determine the rate of evolution of MMT for men and for women at the province level. Average MMT for all of Spain's provinces was 29.4 °C in the case of men and 28.7 °C in the case of women. The MMT for men was greater than that of women in 86 percent of the total provinces analyzed, which indicates greater vulnerability among women. In terms of the rate of variation in MMT during the period analyzed, that of men was 0.39 °C/decade, compared to 0.53 °C/decade for women, indicating greater adaptation to heat among women, compared to men. The differences found between men and women were statistically significant. At the province level, the results show great heterogeneity. Studies carried out at the local level are needed to provide knowledge about those factors that can explain these differences at the province level, and to allow for incorporating a gender perspective in the implementation of measures for adaptation to high temperatures., 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 © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Describe patterns of cause of death by gender, age and territory. The causes of mortality and their possible relationships with health inequalities in the rural and urban population in Spain., Material and Methods: An ecological study of the mortality data of the Spanish population between 2007 and 2013 was carried out. Mortality data were obtained from the National Statistics Institute (INE). To be able to present the data in the grouped and simplified form, the ICD-10 classification detected by the INE was coded with the classification of Disease Load defined by Murray and López (1996), reduced to 21 categories of diseases. The territory variable has been determined: rural / urban, taking as a reference the cut that establishes that populations over 10,000 inhabitants are urban environments and those that are below rural environments. The chi-square test and the Bonferroni-corrected z test for qualitative factors and the Student's t-test for quantitative factors were considered., Results: The results showed than the main causes of death were cardiovascular diseases with 31% (844,010) and malignant tumors with 26.7% (724,889), neuropsychiatric with 8.8% (238,330) and respiratory with 8.7% (235,448). In the rural setting, for the male gender, 52.7% (366,053) died, while 51.3% (995,470) died in the urban environment. Regarding the female gender, the cases of deaths were 47.3% (329,063) in the rural environment and 48.7% (9545.188) in the urban. Related to age, the means of the ages associated with a later death were nutritional conditions with 85.62 years. As for the earliest ages, obviating those related to the deaths of newborns, were the congenital anomalies with 25.37 years of means., Conclusions: Mortality differences were found between the 3axes of social inequality in health-age, gender and territory. Therefore, we can say that social determinants condition our life expectancy., (Copyright © 2019 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)