<p>Descriptive statistics by exposure status.</p>

As climate change exacerbates heatwaves, the health risks for vulnerable populations, particularly older adults, are intensifying. This study examines the relationship between heat exposure and health outcomes among older adults in India, with a focus on the potential moderating roles of socio-demographic factors. We analyzed data from the Longitudinal Aging Study of India-Wave I and climate data from NOAA to assess the association between severe heat exposure and health outcomes. Outcomes included self-reported health, mental health, and outpatient service utilization. We used propensity score matching and regression analysis, including ordered probit models and logistic regressions with robust standard errors, to examine the moderating effects of socioeconomic and environmental factors. Heat exposure was associated with poorer self-reported health (β = -0·17, p < 0·001) and increased depressive symptoms (β = 0·09, p < 0·001) and fatigue (β = 0·08, p = 0·001). Health insurance coverage reduced these negative associations, while homeownership and being female were linked to greater declines in self-reported health. Among those aged 65–84 years, heat exposure was associated with increased outpatient visits (interaction β = 0·33, p = 0·04). Our findings suggest that heat exposure is associated with adverse physical and mental health outcomes among older adults, with health insurance potentially playing a protective role. Targeted interventions may be needed for vulnerable groups, particularly women and those without health insurance.