Health cost impacts of extreme temperature on older adults based on city-level data from 28 provinces in China

Abstract Extreme temperature exposure can have a considerable impact on the health of older adults. China, which has entered a deeply aging society, may be obviously threatened by extreme weather. Based on data obtained from the China Health and Retirement Longitudinal Study (CHARLS), we apply a panel fixed effect model to investigate the impact of extreme temperature on medical costs for older adults. The results reveal a U-shaped relationship between temperature and older adults' medical costs. Heterogeneity analysis indicates that medical costs for older adults in the South and older adults in rural areas are more significantly affected by low temperatures, mainly due to lower per capita heating facilities. Furthermore, the medical costs of older people with lower education levels are also more susceptible to temperature fluctuations. Our simulated prediction indicates that the medical costs of older adults in 2050 will be 2.7 trillion Chinese yuan under the RCP8.5 scenario, but can be reduced by 4.6% and 7.4% following RCP4.5 and RCP2.6 scenarios, respectively. Compared with base period, the medical costs of older adults in western provinces such as Guangxi and Sichuan will more than triple by 2050. Policymakers should prioritize addressing the health needs of these vulnerable groups and less developed regions with less adaptive capacity.