Background Only little is known about trends in temperature–mortality associations among the most vulnerable subgroups, especially in the areas of central and eastern Europe, which are considered major climatic hotspots in terms of heatwave exposure. Thus, we aimed to assess trends in temperature-related mortality in the Czech Republic by sex, age and cause of death, and to quantify the temporal evolution of possible inequalities. Methods We collected daily time series of all-cause (1987–2019) and cause-specific (1994–2019) mortality by sex and age category, and population-weighted daily mean 2-metre temperatures for each region of the Czech Republic. We applied a quasi-Poisson regression model to estimate the trends in region-specific temperature–mortality associations, with distributed lag non-linear models and multivariate random-effects meta-analysis to derive average associations across the country. We then calculated mortality attributable to non-optimal temperatures and implemented the indicator of sex- and age-dependent inequalities. Results We observed a similar risk of mortality due to cold temperatures for men and women. Conversely, for warm temperatures, a higher risk was observed for women. Results by age showed a clear pattern of increasing risk due to non-optimum temperatures with increasing age category. The relative risk (RR) related to cold was considerably attenuated in most of the studied subgroups during the study period, whereas an increase in the RR associated with heat was seen in the overall population, in women, in the age category 90+ years and with respect to respiratory causes. Moreover, underlying sex- and age-dependent inequalities experienced substantial growth. Conclusions Our findings suggest ongoing adaptation to cold temperatures. Mal/adaptation to hot temperatures occurred unequally among population subgroups and resulted in growing inequalities between the sexes and among age categories.

中文翻译：

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捷克共和国全国范围内与炎热和寒冷相关的死亡率趋势分析：近期气候变暖导致不平等现象日益加剧

背景 人们对最脆弱群体中温度与死亡率之间关系的趋势知之甚少，特别是在中欧和东欧地区，这些地区被认为是热浪暴露的主要气候热点地区。因此，我们的目的是按性别、年龄和死因评估捷克共和国与温度相关的死亡率趋势，并量化可能不平等的时间演变。方法 我们收集了捷克共和国每个地区按性别和年龄类别划分的全因死亡率（1987-2019 年）和特定原因死亡率（1994-2019 年）的每日时间序列，以及人口加权的每日平均 2 米气温。我们应用准泊松回归模型来估计特定区域温度与死亡率关联的趋势，并使用分布式滞后非线性模型和多元随机效应荟萃分析来得出全国范围内的平均关联。然后，我们计算了非最佳温度造成的死亡率，并实施了性别和年龄相关的不平等指标。结果 我们观察到男性和女性因低温而死亡的风险相似。相反，在温暖的温度下，女性的风险更高。按年龄划分的结果显示，随着年龄类别的增加，由于非最佳温度而导致的风险明显增加。在研究期间，大多数研究亚组中与寒冷相关的相对风险 (RR) 显着减弱，而在总体人群、女性、90 岁以上年龄组和关于呼吸系统的原因。此外，与性别和年龄相关的潜在不平等现象大幅增长。结论 我们的研究结果表明对寒冷温度的持续适应。对高温的适应不良/适应在人口亚群体中发生的情况不平等，并导致性别之间和年龄类别之间的不平等日益加剧。