Context: tropical areas and small islands are identified as highly vulnerable to climate change, and already experiencing shifts in their temperature distribution. However, the knowledge on the health impacts of temperatures under tropical marine climate is limited. We explored the influence of temperature on mortality in four French overseas regions located in French Guiana, French West Indies, and in the Indian Ocean, between 2000 and 2015. Method: distributed lag non-linear generalized models linking temperature and mortality were developed in each area, and relative risks were combined through a meta-analysis. Models were used to estimate the fraction of mortality attributable to non-optimal temperatures. The role of humidity was also investigated. Results: an increased risk of mortality was observed when the temperature deviated from median. Results were not modified when introducing humidity. Between 2000 and 2015, 979 deaths [confidence interval (CI) 95% 531:1359] were attributable to temperatures higher than the 90th percentile of the temperature distribution, and 442 [CI 95% 178:667] to temperature lower than the 10th percentile. Discussion: heat already has a large impact on mortality in the French overseas regions. Results suggest that adaptation to heat is relevant under tropical marine climate.