MRC DTP in Precision Medicine

Anticholinergic burden, heat exposure and health outcomes: a linked-data approach to tackling inequalities

Supervisors

Dr Claire Niedzwiedz, School of Health and Wellbeing, University of Glasgow

Dr Peter Hanlon, School of Health and Wellbeing, University of Glasgow

Prof Jim Lewsey, School of Health and Wellbeing, University of Glasgow

Dr Mare Sundström, Institute of Environmental Medicine, Karolinska Institutet

Summary

Heatwaves are becoming more frequent and intense in Europe, but their health impacts are not shared equally. Many commonly prescribed medicines, including antipsychotics, antidepressants and antihistamines have anticholinergic effects that can reduce sweating and impair the body’s ability to regulate temperature. A high anticholinergic burden, especially with multiple medicines, may therefore increase vulnerability to heat. People with severe mental illness (SMI), who experience significant health inequalities, are more likely to take multiple medications, experience deprivation and poor housing, may be particularly at risk. Yet heat-health guidance rarely considers medication, and we do not know what social and biological mechanisms increase vulnerability to heat. This PhD will use large-scale linked health data, such as the SAIL Databank (Wales) and other cohorts, with high-resolution environmental data, to quantify how anticholinergic burden modifies the health effects of heat and to identify susceptible groups, including people with SMI. The student will apply a range of statistical techniques, such as distributed lag non-linear models and machine learning. Findings will inform safer prescribing, heat-health guidance and targeted prevention. The student will gain interdisciplinary training in pharmacoepidemiology, environmental epidemiology, biostatistics, with the opportunity to undertake a research visit to Karolinska Institutet (Institute of Environmental Medicine).