Ninety Years Later: Redlining and Opioid-Related Overdose Deaths among Massachusetts Residents, 2015–2019

Abstract: Historical redlining is a mechanism of structural racism and government-sanctioned disinvestment associated with current health inequities. We assigned redlining grades to 2010 census tracts (CT) in Massachusetts using a weighting method and linked 2015–2019 decedent data and CT population estimates. We conducted negative binomial regression to assess the association between opioid-related overdose deaths and weighted CT redlining grade (Best, Still Desirable, Declining, Hazardous). We estimated robust standard errors (Moran's I p<.001) to account for spatial autocorrelation. After adjusting for demographics and CT social vulnerability, compared with CTs graded Best, five-year annual opioid-related overdose death rates were 53% higher in Still Desirable (aIRR: 1.53, 95% CI: 1.03, 2.28), 61% higher in Declining (aIRR: 1.61, 95% CI: 1.07, 2.43), and 86% higher in Hazardous (aIRR: 1.86, 95% CI: 1.18, 2.93) CTs. Historical redlining was associated with current opioid-related overdose deaths, exemplifying the enduring effects of historical racialized policy and structural disinvestment.