RT Journal Article T1 Evidence of rapid adaptation integrated into projections of temperature-related excess mortality A1 Huber, Veronika A1 Peña Ortiz, Cristina A1 Gallego Puyol, David A1 Lange, Stefan A1 Sera, Francesco K1 Temperature-related excess mortality K1 Adaptation K1 Climate change K1 Minimum mortality temperature K1 Human health K1 Heat stress AB Few studies have used empirical evidence of past adaptation to project temperature-related excess mortality under climate change. Here, we assess adaptation in future projections of temperature-related excess mortality by employing evidence of shifting minimum mortality temperatures (MMTs) concurrent with climate warming of recent decades. The study is based on daily non-external mortality and daily mean temperature time-series from 11 Spanish cities covering four decades (1978–2017). It employs distributed lag non-linear models (DLNMs) to describe temperature-mortality associations, and multivariate mixed-effect meta-regression models to derive city- and subperiod-specific MMTs, and subsequently MMT associations with climatic indicators. We use temperature projections for one low- and one high-emission scenario (ssp126, ssp370) derived from five global climate models. Our results show that MMTs have closely tracked mean summer temperatures (MSTs) over time and space, with meta-regression models suggesting that the MMTs increased by 0.73 °C (95%CI: 0.65, 0.80) per 1 °C rise in MST over time, and by 0.84 °C (95%CI: 0.76, 0.92) per 1 °C rise in MST across cities. Future projections, which include adaptation by shifting MMTs according to observed temporal changes, result in 63.5% (95%CI: 50.0, 81.2) lower heat-related excess mortality, 63.7% (95%CI: 30.2, 166.7) higher cold-related excess mortality, and 11.2% (95%CI: −5.5, 39.5) lower total temperature-related excess mortality in the 2090s for ssp370 compared to estimates that do not account for adaptation. For ssp126, assumptions on adaptation have a comparatively small impact on excess mortality estimates. Elucidating the adaptive capacities of societies can motivate strengthened efforts to implement specific adaptation measures directed at reducing heat stress under climate change. PB IOPscience YR 2022 FD 2022-04-08 LK https://hdl.handle.net/10433/20064 UL https://hdl.handle.net/10433/20064 LA en NO Environmental Research Letters, Volume 17, Number 4 NO Departamento de Sistemas Físicos, Químicos y Naturales DS RIO RD May 9, 2026