Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism

Area of Science:

• Public Health
• Sociology
• Urban Studies

Background:

• Black, Indigenous, and Latino communities face disproportionate impacts from the US overdose epidemic.
• Structural inequalities are increasingly recognized as key drivers of these health disparities.

Purpose of the Study:

• To investigate the association between neighborhood-level structural racism and opioid-involved overdose deaths in an urban setting.
• To analyze this association before and during the COVID-19 pandemic.

Main Methods:

• Ecological serial cross-sectional study in Chicago, Illinois (796-792 census tracts, 2017-2022).
• Quasi-Poisson spatial regression and eigenvector spatial filtering used to examine associations.
• A combined index of historical redlining and contemporary racialized economic segregation measured structural racism.

Main Results:

• Census tracts with high historical and/or present-day structural racism showed significantly more fatal overdoses.
• Before the pandemic (2017-2019), high sustained racism tracts had ~2.6 more overdose deaths per tract.
• During the pandemic (2020-2022), tracts with past advantages but present segregation had ~3.8 more overdose deaths per tract.

Conclusions:

• Structural racism is a potential root cause of opioid-involved overdose deaths.
• Findings highlight the need for policies and programs addressing structural racism to reduce overdose fatalities.
• The burden of overdose deaths increased across all neighborhood groups during the pandemic.