Warm temperatures adversely affect disease occurrence and death, in extreme conditions as well as when the temperature changes are more modest^. Therefore climate change, which is expected to affect both average temperatures and temperature variability, is likely to impact health even in temperate climates.

Climate change risk assessment is enriched if there is information on vulnerability and resilience to effects of temperature. Some studies have analysed socio-demographic characteristics that make individuals vulnerable to adverse effects of temperature.

Less is known about community-level vulnerability. We used geo-coded mortality and environmental data and Bayesian spatial methods to conduct a national small-area analysis of the mortality effects of warm temperature for all 376 districts in England and Wales.

In the most vulnerable districts, those in London and south/southeast England, odds of dying from cardiorespiratory causes increased by more than 10% for 1 °C warmer temperature, compared with virtually no effect in the most resilient districts, which were in the far north.

A 2 °C warmer summer may result in 1,552 (95% credible interval 1,307–1,762) additional deaths, about one-half of which would occur in 95 districts. The findings enable risk and adaptation analyses to incorporate local vulnerability to warm temperature and to quantify inequality in its effects.