BACKGROUND: Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality association, indicating long-term adaptation to local climate. Limited evidence about the geographical variability of the MMT is available at a global scale. METHODS: We collected data from 658 communities in 43 countries under different climates. We estimated temperature-mortality associations to derive the MMT for each community using Poisson regression with distributed lag nonlinear models. We investigated the variation in MMT by climatic zone using a mixed-effects meta-analysis and explored the association with climatic and socioeconomic indicators. RESULTS: The geographical distribution of MMTs varied considerably by country between 14.2 and 31.1 °C decreasing by latitude. For climatic zones, the MMTs increased from alpine (13.0 °C) to continental (19.3 °C), temperate (21.7 °C), arid (24.5 °C), and tropical (26.5 °C). The MMT percentiles (MMTPs) corresponding to the MMTs decreased from temperate (79.5th) to continental (75.4th), arid (68.0th), tropical (58.5th), and alpine (41.4th). The MMTs indreased by 0.8 °C for a 1 °C rise in a community's annual mean temperature, and by 1 °C for a 1 °C rise in its SD. While the MMTP decreased by 0.3 centile points for a 1 °C rise in a community's annual mean temperature and by 1.3 for a 1 °C rise in its SD. CONCLUSIONS: The geographical distribution of the MMTs and MMTPs is driven mainly by the mean annual temperature, which seems to be a valuable indicator of overall adaptation across populations. Our results suggest that populations have adapted to the average temperature, although there is still more room for adaptation.

Center for Climate Change Adaptation National Institute for Environmental Studies Tsukuba Japan

Center for Environmental and Respiratory Health Research University of Oulu Oulu Finland

Centre for Statistical Methodology

Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine London United Kingdom

Department of Earth Sciences University of Torino Torino Italy

Department of Environmental Health Faculty of Public Health University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh City Vietnam

Department of Environmental Health Harvard T H Chan School of Public Health Harvard University Boston Massachusetts

Department of Environmental Health National Institute of Public Health Cuernavaca Morelos Mexico

Department of Environmental Health School of Public Health Fudan University Shanghai China

Department of Environmental Health University of São Paulo São Paulo Brazil

Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne

Department of Epidemiology Instituto Nacional de Saúde Dr Ricardo Lisboa

Department of Epidemiology Lazio Regional Health Service Rome Italy

Department of Family Medicine and Public Health University of Tartu Tartu Estonia

Department of Geography University of Santiago de Compostela Santiago de Compostela Spain

Department of Global Environmental Health Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Global Health Policy Graduate School of Medicine The University of Tokyo Tokyo

Department of Hygiene Epidemiology and Medical Statistics National and Kapodistrian University of Athens Greece

Department of Mathematical Sciences Korea Advanced Institute of Science and Technology Daejeon South Korea

Department of Pathology Faculty of Medicine University of São Paulo São Paulo Brazil

Department of Physical Chemical and Natural Systems Universidad Pablo de Olavide Sevilla Spain

Department of Public Health and Clinical Medicine Umeå University Umeå Sweden

Department of Public Health Environments and Society

Department of Public Health Universidad de los Andes Santiago Chile

Department of Quantitative Methods School of Medicine University of the Republic Montevideo Uruguay

Department of Statistics and Computational Research Universitat de València València Spain

Department of Statistics Computer Science and Applications G Parenti University of Florence Florence Italy

Environmental and Occupational Medicine and Institute of Occupational Medicine and Industrial Hygiene National Taiwan University and NTU Hospital Taipei

Environmental Research Group MRC Centre for Environment and Health School of Public Health Imperial College London London United Kingdom

EPIUnit Instituto de Sa√∫de P√∫blica Universidade do Porto Porto Portugal

Faculty of Geography and Environmental Sciences Hakim Sabzevari University Sabzevar Khorasan Razavi Iran

Faculty of Geography Babes Bolay University Cluj Napoca Romania

Gangarosa Department of Environmental Health Rollins School of Public Health Emory University Atlanta

Graduate School of Public Health Seoul National University Seoul Republic of Korea

Institute for the Environment Brunel University London London United Kingdom

Institute of Atmospheric Physics Academy of Sciences of the Czech Republic Prague Czech Republic

Institute of Environmental Assessment and Water Research Barcelona Spain

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Institute of Social and Preventive Medicine

Institute of Tropical Medicine Alexander von Humboldt Universidad Peruana Cayetano Heredia Lima Peru

National Agency for Public Health of the Ministry of Health Labour and Social Protection of the Republic of Moldova

National Institute for Public Health and the Environment Centre for Sustainability and Environmental Health Bilthoven The Netherlands

National Institute of Environmental Health Science National Health Research Institutes Zhunan Taiwan

Norwegian institute of Public Health Oslo Norway

Oeschger Center for Climate Change Research University of Bern Bern Switzerland

Santé Publique France Department of Environmental Health French National Public Health Agency Saint Maurice France

School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa Canada

School of Public Health and Social Work Queensland University of Technology Brisbane Australia

School of the Environment Yale University New Haven Connecticut

School of Tropical Medicine and Global Health Nagasaki University Nagasaki

Swiss Tropical and Public Health Institute

Technological University Dublin Ireland

Universidad de Buenos Aires Facultad de Ciencias Sociales Instituto de Investigaciones Gino Germani Buenos Aires

University of Basel Basel Switzerland

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