More than 60,000 people died as a result of record-breaking temperatures in Europe last summer, a study has found, raising concerns about multiple countries’ lack of preparation for extreme heat fueled by climate change.

Between May 30 and Sept. 4 of last year, there were 61,672 deaths caused by hot weather across 35 European countries, according to the study by researchers at the Barcelona Institute for Global Health and the French National Institute of Health, published in the journal Nature Medicine. Last year’s was the warmest summer ever recorded on the continent, breaking a record set just one year earlier. Temperatures were more than 2C above the recent average for countries that included France, Switzerland and Spain.

Last year’s extreme-heat casualties echo an earlier hot summer in 2003, when 70,000 excess deaths were recorded across Europe. The loss of life led several countries to introduce early-warning systems for heat waves, as well as more planning around health care services. But the large number of deaths in 2022 shows the limitations of these measures, the study’s authors noted.

“The fact that more than 61,600 people in Europe died of heat stress in the summer of 2022, even though, unlike in 2003, many countries already had active prevention plans in place, suggests that the adaptation strategies currently available may still be insufficient,” said Hicham Achebak, one of the study’s authors, in a press release.

Older people and women were particularly impacted last year. Heat-related mortality was 63% higher in women than in men, and more than half of the deaths were of people over 79. Italy had the largest number of heat-linked deaths, followed by Spain and Germany. While temperatures in France and Switzerland were furthest from the norm, the highest death rates were recorded in Italy, Greece, Spain and Portugal, suggesting people in Mediterranean countries are particularly vulnerable.

Europe is the world’s fastest-warming continent. In the UK specifically, 2022 saw multiple days above 40C (104F) — temperatures that would have been “extremely unlikely” without climate change, a separate study concluded last year. The continent also includes many places with aging populations and housing and infrastructure ill-adapted to extreme heat.

“The temperatures recorded in the summer of 2022 cannot be considered exceptional, in the sense that they could have been predicted by following the temperature series of previous years,” said Joan Ballester Claramunt, lead author of the Nature Medicine study. “[They] show that warming has accelerated over the last decade.”

If better planning is not introduced, the study concluded, heat-linked deaths could average 68,000 in Europe every summer by 2030, and 120,610 by 2050.