Spatial Patterns of Opioid Overdose Mortality Risk Across Urban, Transitional, and Rural Communities Using Satellite-Derived and Socioeconomic Indicators

Geographic differences in drug overdose patterns across the rural-urban continuum are well documented. Few studies utilize remote sensing data to assess environmental and structural factors influencing overdose risk across different geographic scales. We performed a retrospective ecological study analyzing fatal opioid overdoses within census block groups in Cook County, Illinois, from 2018 to 2023. Urbanicity was classified using the Global Human Settlement Layer Model (GHSL-MOD), which employed satellite data to measure built-up intensity, vegetative greenness, and nighttime light intensity (NLI). Environmental indicators were combined with census-based measures of neighborhood deprivation to characterize spatial variation in physical and social conditions. A Bayesian spatiotemporal model was estimated to account for spatial dependence, temporal trends, and environmental exposures, yielding neighborhood-level estimates of overdose risk. Overdose risk exhibited significant spatial clustering and strong associations with both social and environmental factors. Neighborhood disadvantage had a dose-response relationship, with fatal overdose risk in areas with the most deprivation, experiencing over seven times the risk, compared to the least deprived. NLI was strongly associated with increased overdose risk, while vegetative greenness and park access showed no significant protective effects. Increasing trends were detected in rural and transitional zones despite a higher risk in urban centers. Demographic characteristics of overdose victims varied across the county, suggesting potential geographic disparities in risk. The physical and social features of neighborhoods underscore the need for early surveillance and intervention within and outside urban centers. These factors should be incorporated into targeted, place-based strategies to lower opioid-related deaths.