International Journal of Public Health

, Volume 64, Issue 1, pp 27–37 | Cite as

Social inequalities in the association between temperature and mortality in a South European context

  • Marc Marí-Dell’OlmoEmail author
  • Aurelio Tobías
  • Anna Gómez-Gutiérrez
  • Maica Rodríguez-Sanz
  • Patricia García de Olalla
  • Esteve Camprubí
  • Antonio Gasparrini
  • Carme Borrell
Original Article



To analyse social inequalities in the association between ambient temperature and mortality by sex, age and educational level, in the city of Barcelona for the period 1992–2015.


Mortality data are represented by daily counts for natural mortality. As a measure of socioeconomic position, we used the educational level of the deceased. We also considered age group and sex. We considered, as a measure of exposure, the daily maximum temperatures. Time-series Poisson regression with distributed lag non-linear models was fitted for modelling the relationship between temperature and mortality.


Women had higher risk of mortality by hot temperatures than men. Temperature–mortality association (heat and cold) was evident for the elderly, except for heat-related mortality in women which was present in all age groups. Men with primary education or more were more vulnerable to moderate or extreme temperatures than those without studies. Finally, women were vulnerable to heat-related mortality in all educational levels while women without studies were more vulnerable to cold temperatures.


Social and economic individual characteristics play an important role in vulnerability to high and low temperatures. It is important that decision-making groups consider identified vulnerable subgroups when redacting and implementing climate change resilience and adaptation plans.


Socioeconomic inequalities Mortality Temperature Cold Heat Climate change 



This article was partially funded by CIBER Epidemiología y Salud Pública (CIBERESP). Dr. Gasparrini was supported from a grant from Medical Research Council UK (Grant ID: MR/M022625/1). Moreover, we want to thank “Servei Meteorològic de Catalunya” (METEOCAT) for providing temperature data.

Authors’ contributions

All authors meet the conditions of authorship. MMDO and AT contributed in the conception and design of the study. All the authors contributed to the acquisition and interpretation of data. MMDO, AT and AG performed the statistical analyses. All the authors contributed in the interpretation and the discussion of the results. MMDO wrote the first draft of the paper. All the authors critically revised the manuscript and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article is based on a secondary analysis of administrative data, and does not contain any studies with human participants performed by any of the authors. Obtaining informed consent or approval by a medical ethics board was not required under national regulations.

Supplementary material

38_2018_1094_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 35 kb)


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Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Marc Marí-Dell’Olmo
    • 1
    • 2
    • 3
    • 4
    Email author
  • Aurelio Tobías
    • 5
  • Anna Gómez-Gutiérrez
    • 1
  • Maica Rodríguez-Sanz
    • 1
    • 2
    • 3
    • 4
  • Patricia García de Olalla
    • 1
    • 2
    • 3
    • 4
  • Esteve Camprubí
    • 1
  • Antonio Gasparrini
    • 6
  • Carme Borrell
    • 1
    • 2
    • 3
    • 4
  1. 1.Agència de Salut Pública de BarcelonaBarcelonaSpain
  2. 2.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  3. 3.Institut d’Investigació Biomèdica (IIB Sant Pau)BarcelonaSpain
  4. 4.Universitat Pompeu FabraBarcelonaSpain
  5. 5.Institute of Environmental Assessment and Water Research (IDAEA)Spanish Council for Scientific Research (CSIC)BarcelonaSpain
  6. 6.London School of Hygiene and Tropical MedicineLondonUK

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