Background: urban heat island (UHI) is being intensified with the progress of urbanization. Meanwhile, res-piratory diseases caused by high temperature become common. This study explores the influences of UHI on respiratory diseases (J00-J99) and the evolutionary characteristics of the spatial pattern of such influences. Methods: The pattern– process– function and the influencing mechanism of UHI on respiratory diseases were evaluated through landscape pattern indexes from 1992 to 2018 in Tianjin, China. The basis was on data from Landsat TM/OLI/TIRS remote-sensing images, meteorological stations, and mortality of respiratory diseases. Results: The fluctuating influence of UHI on the respiratory diseases in Tianjin has increased from 1992 to 2018, showing a significant phase-based characteristic. During 2011-2018, the influence has soared greatly, and mortality risk has increased by 101%, and the influenced area has reached 349 km² . Furthermore, the regional space clustered, and the influenced patches are in irregular shape, and the highly influenced area is enlarged. Moreover, the indexes of the landscape level of the influenced areas all decrease. The patches at all levels are fragmented and distributed discontinuously. Spatially, the influenced areas gradually extend from the urban center to the suburbs. Conclusion: UHI causes a higher mortality of respiratory diseases because it increases daily average air tem-perature in summer. With respect to landscape pattern, the influenced areas at low level is highly interconnect-ed and relatively concentrated, whereas the influenced area at high level is distributed in clusters. In general, the influenced area is fragmented and discontinuously distributed in urban center.