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This paper explores the historical relationship between weather fluctuations and mortality evolution in China. Using panel data on the annual provincial mortality rate and daily weather variables for the 1964–2008 period, we applied a dynamic model structure with sufficient controls to estimate the short-term effects of temperature shocks on China's mortality rate. Our main results show that an additional 1 °C rise in average temperature in a given year increases the annual mortality rate by an average of 3.2%. In addition, days with daily average temperatures exceeding 27 °C (30 °C) are associated with an increase in the annual mortality rate of nearly 0.1% (0.2%) or approximately 9,520 (19,040) additional deaths. In contrast, extremely cold days do not have these effects. By applying a hybrid model structure (the long difference approach) to examine the medium-term effects of temperature changes, we find that there is little evidence of overall adaptation to high temperatures when moving from the short term to the medium term. In addition, by introducing interactions between temperatures and potential modifiers such as access to doctors, hospital beds, air conditioning and refrigerators, we determined that only residential air conditioning played an important role in mitigating the temperature-mortality relationship. However, the penetration of air conditioning in China is still relatively low. These findings indicate that climate change could partially explain the historical phenomenon of China's rising mortality rate during the unprecedented economic boom experienced since the 1980s. • Increases in the number of extreme hot days increase annual mortality rate. • Little evidence of adaptation when moving from short run to medium run. • Residential air conditioning has played an important role in mitigating the temperature-mortality relationship. [ABSTRACT FROM AUTHOR]