Risk of Drug Overdose Death among Residents of Urban Census Tracts with Low-Level Opportunity: How Granular Geographical Analyses Uncovers Socioenvironmental Correlates of Drug-related Mortality in Cuyahoga County, Ohio

Abstract Geostatistical data aggregated at state, county, municipality, or ZIP code levels often are utilized for assessing drug overdose epidemic impact and planning resource distribution. However, data aggregated at these levels may obscure critical disparity among populations experiencing high rates of drug-related mortality (DRM), especially in densely populated urban areas. This study centered on Cuyahoga County (Cleveland), Ohio, which ranks as the 15th deadliest county in the United States for drug-related mortality. It builds on recent studies that adopted a finer geographical lens by examining DRM rates at the census tract level. Our investigation used Cuyahoga County census tracts with high and low DRM rates and compared them with Cuyahoga County census tracts with high and low levels of opportunity as developed by a statewide opportunity index available to the public. Analyzing DRM data from 2014 to 2022, we found that the odds of DRM in low-opportunity areas were quadruple that in high-opportunity zones. Our findings highlight the critical need for more granular geographic analysis in urban areas, where heterogenous socioeconomic and environmental conditions appear to correlate with significant heterogeneity in the ways in which residents experience the overdose epidemic. By focusing on smaller areas, this approach provides a clearer understanding of the DRM landscape that could facilitate the prioritization of targeted public health responses and interventions for communities most at risk.