Assessing Health Impacts of Extreme Weather on American Indian, Rural Populations with Multisystem Electronic Health Records

PROJECT SUMMARY/ABSTRACT
Extreme weather events, such as heatwaves, droughts, and wildfires are manifestations of a changing climate.
The Upper Midwest is particularly vulnerable to climatic shifts with Minnesota experiencing the most extreme
wintertime warming of any contiguous state. Climate impacts are regionally visible, as food sources culturally
important to indigenous tribes have diminished and transitory wildfire smoke events from Canada have
produced alarming air pollution events. The Upper Midwest is further home to historically underrepresented
populations, including rural and American Indian (AI) residents. These individuals experience some of the
largest U.S. health disparities, including higher comorbidities, outdoor and physical occupations, and persistent
structural inequities including a sparsity of rural healthcare access. Other unique risk factors may play
additional roles in modifying extreme heat health effects, including the use of climate-sensitive medications that
disrupt thermoregulation. To evaluate the impacts of extreme weather on high concern Upper Midwest
populations, we will partner with the Minnesota electronic health records consortium (MNEHR); a unique group
with 9 of the largest Minnesota health care providers giving us access to electronic health records for a near
complete capture of Minnesota’s population (61,000 AI individuals, ~2 million rural residents). This consortium
represents a key resource innovation, as it supports the identification and investigation of high disparity
populations while keeping data secure and private. Our team will further collaborate with our Community
Engagement Core to seek input on research with minoritized populations and ensure that any public health
findings are effective and culturally appropriate. In Aim 1, we will characterize the spatiotemporal variability of
extreme weather in the Upper Midwest and link weather events with sociodemographic data to identify
hotspots and at-risk communities. This database will become a public resource for people evaluating regional
climate change. In Aim 2, we will assess extreme weather impacts among high-climate concern American
Indian and rural residents in Minnesota. We will estimate the association between extreme heat, cold, wildfire
air pollution, and compound events of heat plus wildfire and heat plus drought and healthcare admissions for
cardiopulmonary, heat-related or fluid disorders, non-accidental injury, and mental health issues. In Aim 3, we
will assess how climate-sensitive medication may be a unique risk factor for modifying medical encounters
during extreme heat events. Patients prescribed diuretics, SLT2i inhibitors, and anticholinergics and may show
exacerbated health risks during extreme heat exposures. Our research will play a critical role in the Mni Sota
Center for Climate Change and Health by building Midwest climate and health research capacity, developing
new climate partnerships, and bringing together climate and health stakeholders for public health practice and
clinical decision. Our research framework will provide a blueprint for future analysis of climate, weather, and
health, including the translation of our work to new regional partners.

Grant Number: 5P20MD019990-02
NIH Institute/Center: NIH
Principal Investigator: Jesse Berman