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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 an

Background An area of current study concerns analysis of the possible adaptation of the population to heat, based on the temporal evolution of the minimum mortality temperature (MMT). It is important to know how is the evolution of the threshold temperatures (Tthreshold) due to these temperatures provide the basis for the activation of public health prevention plans against high temperatures. The objective of this study was to analyze the temporal evolution of threshold temperatures (Tthreshold) produced in different Spanish regions during the 1983–2018 period and to compare this evolution with the evolution of MMT. The dependent variable used was the raw rate of daily mortality due to natural causes ICD X: (A00-R99) for the considered period. The independent variable was maximum daily temperature (Tmax) during the summer months registered in the reference observatory of each region. Threshold values were determined using dispersion diagrams (annual) of the prewhitened series of mortality temperatures and Tmax. Later, linear fit models were carried out between the different values of Tthreshold throughout the study period, which permitted detecting the annual rate of change in Tthreshold. Results The results obtained show that, on average, Tthreshold has increased at a rate of 0.57 ºC/decade in Spain, while Tmax temperatures in the summer have increased at a rate of 0.41 ºC/decade, suggesting adaptation to heat. This rate of evolution presents important geographic heterogeneity. Also, the rate of evolution of Tthreshold was similar to what was detected for MMT. Conclusions The temporal evolution of the series of both temperature measures can be used as indicators of population adaptation to heat. The temporal evolution of Tthreshold has important geographic variation, probably related to sociodemographic and economic factors, that should be studied at the local level.

The objective of this study is to analyze the short-term effects of atmospheric pollutant concentrations (PM10, NO2 and O3) and heat and cold waves on the number of pre-term births and cases of low birth weight related to Saharan dust advection and biomass combustion. The dependent variables used in this analysis were the total number of births, births with low weight (>2.500 g) and pre-term births (<37 weeks), that occurred at the province level. Data provided by the NSI included: days with Saharan dust intrusion or biomass advection classified in terms of information provided by MITECO for each of the nine regions in Spain. A representative city was selected for reach region in which the registered average daily concentrations of PM10, NO2 and O3 (μg/m3) were used. These were also provided by MITECO. The daily maximum and daily minimum temperature (°C) used was those registered by the meteorological observatory station located in each province capital, provided by AEMET. Using Poisson log linear regression models, the associated relative risks (RR) were measured as well as the population attributable risk (PAR) corresponding to the variables that resulted statistically significant at p < 0.05 for days with and without intrusion of natural particulate matter. The results obtained show that the days with Saharan dust intrusion or advections due to biomass combustion- beyond the impact of PM10, primary pollutants such as NO2 (in Saharan intrusions), heat waves and O3 - are associated with the number of births, low birth weight and pre-term birth. The RR and percent PAR of the pollutants and the heat waves are greater than those obtained for PM10. The results of this study indicate that days with natural particulate matter due to biomass combustion or advection of Saharan dust put pregnant women at risk.

The increase in the frequency and intensity of heat waves is one of the most unquestionable effects of climate change. Therefore, the progressive increase in maximum temperatures will have a clear incidence on the increase in mortality, especially in countries that are vulnerable due to geographical location or their socioeconomic characteristics. Different research studies show that the mortality attributable to heat is decreasing globally, and research is centred on future scenarios. One way of detecting the existence of a lesser impact of heat is through the increase in the so-called temperature of minimum mortality (TMM). The objective of this study is to determine the temporal evolution of TMM in two Spanish provinces (Seville and Madrid) during the 1983–2018 period and to evaluate whether the rate of adaptation to heat is appropriate. We used the gross rate of daily mortality due to natural causes (CIEX: A00-R99) and the maximum daily temperature (°C) to determine the quinquennial TMM using dispersion diagrams and realizing fit using quadratic and cubic curvilinear estimation. The same analysis was carried out at the annual level, by fitting an equation to the line of TMM for each province, whose slope, if significant (p < 0.05) represents the annual rate of variation in TMM. The results observed in this quinquennial analysis showed that the TMM is higher in Seville than in Madrid and that it is higher among men than women in the two provinces. Furthermore, there was an increase in TMM in all of the quinquennium and a clear decrease in the final period. At the annual level, the linear fit was significant for Madrid for the whole population and corresponds to an increase in the TMM of 0.58 °C per decade. For Seville the linear fits were significant and the slopes of the fitted lines was 1.1 °C/decade. Both Madrid and Seville are adapting to the increase in temperatures observed over the past 36 years, and women are the group that is more susceptible to heat