Spatiotemporal Dynamics of Heat-Related Health Risks of Elderly Citizens in Nanchang, China, Under Rapid Urbanization

Heatwaves intensified by climate change increasingly threaten urban populations, especially the elderly. However, most existing studies have concentrated on short-term or single-scale analyses, lacking a comprehensive understanding of how land cover changes and urbanization affect the vulnerability of the elderly to extreme heat. This study aims to investigate the spatiotemporal distribution patterns of heat-related health risks among the elderly in Nanchang City and to identify their key driving factors within the context of rapid urbanization. This study employs Crichton’s risk triangle framework to the heat-related health risks for the elderly in Nanchang, China, from 2002 to 2020 by integrating meteorological records, land surface temperature, land cover data, and socioeconomic indicators. The model captures the spatiotemporal dynamics of heat hazards, exposure, and vulnerability and identifies the key drivers shaping these patterns. The results show that the heat health risk index has increased significantly over time, with notably higher levels in the urban core compared to those in suburban areas. A 1% rise in impervious surface area corresponds to a 0.31–1.19 increase in the risk index, while a 1% increase in green space leads to a 0.21–1.39 reduction. Vulnerability is particularly high in economically disadvantaged, medically under-served peripheral zones. These findings highlight the need to optimize the spatial distribution of urban green space and control the expansion of impervious surfaces to mitigate urban heat risks. In high-vulnerability areas, improving infrastructure, expanding medical resources, and establishing targeted heat health monitoring and early warning systems are essential to protecting elderly populations. Overall, this study provides a comprehensive framework for assessing urban heat health risks and offers actionable insights into enhancing climate resilience and health risk management in rapidly urbanizing regions.