Abstract
BACKGROUND: Extreme heat events (EHEs) are a growing threat to health worldwide. To date, only a limited number of studies have evaluated medications as risk or protective factors for mortality during EHEs. METHODS: We explored the relationship between dispensed pharmaceuticals and heat-related community deaths using linked administrative health data and both logistic regression (LR) and machine learning (ML) models. We conducted a case-control study during the 2021 EHE in British Columbia, Canada, including 504 community deaths from heat exposure as cases and 2520 similar controls who survived the EHE. We used medications dispensed 30, 60 and 90 days prior to death (or 30, 60 and 90 days before the end of the EHE for controls) as predictors, grouped by Anatomical Therapeutic Chemical (ATC) classification at level 2 for LR (28 classes) and level 4 for ML (270 subclasses). Models were adjusted for multiple covariates, including common chronic diseases. FINDINGS: Results from LR showed increased odds of mortality associated with dispensations of antiepileptics, anti-Parkinson drugs, psycholeptics, diuretics, drugs for diabetes, beta blocking agents, analgesics, urologicals and drugs for treatment of bone diseases. We observed a protective association with dispensations of calcium channel blockers and ophthalmologicals. Results varied by sex, age, and other covariates. The ML model highlighted the most computationally important subclasses of medications within each of the ATC level 2 classes. INTERPRETATION: This study leveraged both LR and ML to generate insights about medications and mortality during EHEs. The results add to the existing evidence on pharmaceutical risks during EHEs and provide new avenues for further research. They can be used to help develop more targeted messages to inform individuals whose medications put them at greater risk during EHEs. FUNDING: BC Centre for Disease Control and Ministère de l'Enseignement supérieur du Québec.