Abstract Background Taiwan is one of the fastest-warming regions globally. As climate change intensifies, understanding how vulnerability influences health outcomes critical. This study aimed to identify regional vulnerability factors for temperature-related respiratory mortality and effective region-specific adaptation policies. Methods A two-stage time-series study was conducted using daily respiratory mortality counts aggregated by county and day. This study employed a distributed lag non-linear model to estimate the temperature-attributable mortality burden from respiratory diseases across all counties and cities in Taiwan. A two-stage meta-analysis was conducted to estimate temperature–mortality associations and quantify cold- and heat-related mortality burdens by county. Meta-regression was used to identify regional vulnerability factors modifying temperature-related mortality risk, and geographically weighted regression (GWR) was applied to characterize the spatial heterogeneity of these effects across counties. Results Cold exposure was linked to a higher burden of respiratory disease mortality (attributable fraction AF: 2.03%, 95% CI: 1.10–2.95) than heat exposure (AF: 1.02%, 95% CI: 0.65–1.40). For cold-related AFs, higher proportions of Indigenous populations (3.27, 0.79–5.75), low-income populations (2.11, 0.67–3.55), greater population density (2.21, 0.46–3.96), and children (0.98, 0.35–1.61) were significantly associated with increased risk, suggesting vulnerability factors. GWR further showed that hospital bed availability had statistically significant protective effects against cold-related AF in 10 of 19 counties (β = − 5.24 to − 6.78), most pronounced in remote mountainous counties (Hualien, Taitung, Kaohsiung). Conclusion Higher proportions of Indigenous populations, low-income population, and children amplify cold-related respiratory mortality. Hospital bed availability confers the strongest protection against cold-related mortality in remote, mountainous counties. Climate adaptation policies for cold-related respiratory health should therefore be tailored to local vulnerability profiles, prioritizing healthcare expansion in geographically remote counties rather than applying uniform investment across all regions.
Yang et al. (Sat,) studied this question.