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 a...