Degrees of inequality: How educational attainment shapes mortality associated to non-optimal temperatures in different provinces of Belgium.

This study investigates how educational attainment influences temperature-related mortality among the elderly across Belgian provinces, addressing a critical gap in understanding climate-related health inequalities. While climate change poses a major global health threat, evidence on socioeconomic disparities in temperature-mortality associations remains limited. Educational attainment can shape vulnerability through multiple pathways: enhanced cognitive skills improve risk assessment and adaptation, and higher socioeconomic status enables protective investments. Prior research suggests that lower-educated populations face greater risks, though findings vary across contexts.

Previous research has shown that different regions in Belgium exhibit distinct mortality patterns, influenced partly by individual socioeconomic status but also by regional socioeconomic conditions and environmental factors. Using Belgian mortality data spanning from 2000 to 2019 and a two-stage meta-regression framework, we examine temperature-mortality relationships across two models: age and education stratification. The analysis focuses on individuals aged 65 and over across 11 provinces, distinguishing between low, secondary, and superior education levels. We use meta-predictors at the provincial level to identify underlying socioeconomic and environmental factors that drive geographic variations in temperature-mortality vulnerability, moving beyond individual-level characteristics to capture contextual determinants of climate health inequalities.

Results reveal strong age gradients consistent with existing literature, with adults aged over 85 experiencing substantially higher temperature-related mortality than younger elderly groups. Educational gradients are also observed as expected, with the lowest educated populations showing higher overall risk, though these effects remain statistically uncertain due to wide confidence intervals at the highest and lowest temperature percentiles. Given the temperature distribution, cold-related mortality predominates across all groups, though risk is higher at warmer temperatures. Regional patterns emerge in line with prior findings, with southern provinces generally showing higher excess mortality than northern areas, confirming the anticipated north-south divide in temperature-related mortality vulnerability.

The analysis will be extended by incorporating additional years of mortality data and additional metadata to better capture vulnerability factors. Furthermore, patterns will be examined at smaller geographical units to identify localized disparities in temperature-related mortality risk. To address the changing nature of education and potential cohort effects, educational attainment differentials will be used to ensure appropriate interpretation of educational disparities across cohorts. The measured relative risks will be used to project changes in mortality under different Shared Socioeconomic Pathways, enabling assessment of future climate change impacts on vulnerable populations.