Regions with greater socioeconomic inequalities are more affected by cold weather, whereas areas with higher levels of wealth and urbanisation are at greater risk during heatwaves and lower risk during cold spells. This is shown by a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation. The results, published in Nature Health , for the first time quantify across the urban and rural population of 32 European countries how socioeconomic inequalities influence temperature-related mortality.
The impacts of climate change on health are already measurable and, unless adaptation and mitigation measures are implemented, they will increase in the coming decades. In Europe, between 2022 and 2024, more than 180,000 deaths associated with heat were recorded, confirming that temperature is becoming a key determinant of public health . Although cold currently causes more deaths than heat, global warming will probably reduce this difference or even reverse it , placing thermal exposure (both heat and cold) at the centre of environmental epidemiology.
However, the risk is not uniform. Due to socioeconomic disparities, climate does not affect everyone equally; environmental temperatures have a disproportionate impact on disadvantaged populations. Even in high-income regions, the consequences vary between territories and social groups – factors such as wealth distribution, housing conditions and socioeconomic structure shape vulnerability. This is the first study to evaluate data from both urban and rural areas, thereby representing the whole European population.
"We analysed daily mortality data in 32 European countries, including more than 161 million deaths between 2000 and 2019, recorded within the framework of the project EARLY-ADAPT , funded by the European Research Council (ERC)," explains Blanca Paniello-Castillo , ISGlobal researcher and first author of the study. "The aim of the research was to assess how different socioeconomic indicators modify the relationship between temperature and mortality in the European population."
Social deprivation, a risk factor for extreme temperatures
Regions with higher levels of social deprivation are consistently more vulnerable to both heat and cold. Factors such as energy poverty, poorer housing conditions, reduced access to healthcare or lower health literacy may all contribute to increased risk.
Indicators such as the Gini index (which measures inequality in wealth distribution within a population), difficulties in keeping the home warm, and material and social deprivation are consistently associated with higher temperature-related mortality.
The study estimates temperature-attributable deaths by comparing two hypothetical scenarios: one in which all regions have the most favourable socioeconomic conditions, and another in which all are at the least favourable extreme. The difference in the number of deaths between the two scenarios exceeds 300,000 in the case of inability to keep the home warm, reaches 177,000 in relation to economic inequality, and is around 157,000 in the case of severe material and social deprivation in Europe.
Economic prosperity protects against cold, but not against heat
Regions with higher GDP per capita and longer life expectancy show lower mortality associated with cold, probably due to better insulated housing, stronger healthcare systems and lower energy poverty.
However, these same regions show higher mortality during heat. This phenomenon may be explained by intense urbanisation: dense cities and concentrated economic activity favour the "urban heat island" effect. In this climatic phenomenon, urbanised areas experience higher temperatures due to heat absorption by asphalt and the lack of vegetation, among other factors.
"Because climate change does not affect all populations equally, our results help assess and strengthen how socioeconomic factors are incorporated into adaptation policies," explains Joan Ballester , principal investigator of the EARLY-ADAPT project and coordinator of the study. "Similar studies are needed in other regions. Although we know Europe is highly exposed to climate risks, there are still few comparable studies in the Global South," he concludes.
Reference
Paniello-Castillo B, Chen ZY, Shartova N, Méndez Turrubiates RF, Beltrán N, Peyrusse F, et al. Socioeconomic inequality drivers of vulnerability and burden to heat- and cold-related mortality: a European-wide analysis in 654 contiguous regions. Nat Health. May, 2026. https://doi.org/10.1038/s44360-026-00106-0
