Examining Opioid Overdose Deaths across Communities Defined by Racial Composition: a Multiscale Geographically Weighted Regression Approach

Abstract

To provide data that can guide community-targeted practices, policies, and interventions in urban metropolitan areas, we used geospatial analysis to examine the community-level opioid overdose death determinants and their spatial variation across a study area. We obtained spatial datasets containing multiple, high-quality measures of socioeconomic conditions, public health status, and demographics for analysis and visualization in geographic information systems. We employed a multiscale modeling approach (multiscale geographically weighted regression; MGWR) to provide a comprehensive and robust analysis of opioid overdose death determinants, explain how geospatial patterns vary across scales across Milwaukee County in 2019, and examine the differential influence of factors locally, regionally, and globally. We subsequently examined how associations varied with the racial/ethnic composition of communities by dividing Milwaukee County into White-majority, Black-majority, and Hispanic-majority regions according to census data and conducting separate, independent modeling processes. Overall, the multiscale model explained 83% of opioid overdose death variability across neighborhoods in Milwaukee County using 12 selected variables. Statistical analysis and geovisualization of patterns, trends, and clusters using MGWR unveiled dramatic racialized health disparities in Milwaukee, showing how factors that influenced opioid overdose deaths varied across diverse communities in Milwaukee. The observed geographic variation in relationships included the impact of naloxone availability and incarceration rates on overdose deaths with pronounced differences between White communities and communities of color. Understanding, community-level factors that contribute to overdose risk should guide targeted community-level solutions. Overall, our findings demonstrate the value of precision epidemiology using MGWR analysis for defining and guiding responses to public health challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00554-x.

Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis

“…4 ). This corresponds with findings from our previous study [ 17 ] that the policies, resources, and interventions that are being designed and implemented in Milwaukee County are primarily benefiting White communities, not communities of color. The low impact of policy interventions in Black and Hispanic communities has further widened their pre-existing health inequalities.…”

“…It is attentive to place-based differences and racialized health disparities and offers unique empirical insights for effective policy responses. The study extends our past research on Milwaukee’s pre-pandemic opioid crisis [ 17 ], which highlighted both the gravity of the crisis among low-income Black and Hispanic neighborhoods and the ineffectiveness of harm reduction policy responses within such neighborhoods. This paper offers new empirical and methodological contributions to assist in the formulation of data-guided policy interventions, so that lives in vulnerable communities can be saved.…”

“…The hyper-segregated City of Milwaukee (population 590,157) exhibits concentrated urban poverty in neighborhoods occupied primarily by Black and Hispanic communities [ 18 ]. Fatal overdose rates are related to such racial and economic segregation [ 17 ], making Milwaukee an appropriate case study for examining the effects of the pandemic on OODs.…”

Opioid overdose decedent characteristics during COVID-19

“…There was also a statistically significant shift in racial demographics among decedents in North Carolina, but this shift was not attributed to the increase in Black non-Hispanic decedents. This trend towards increasing deaths among Black non-Hispanic people necessitates further research to identify the cause, including potentially compounding effects of COVID-19 on rates of synthetic opioid-related deaths among Black people [ 25 ], which may be further exacerbated by the differential impacts of COVID-19 to factors including employment, housing, and access to health care and other services [ 26 , 27 ]. However, Black overdose death rates were increasing even prior to the COVID-19 pandemic, and could reflect shifts in the drug supply that are only just now beginning to affect Black people who use drugs [ 25 ].…”

Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change

“…We used this regional division because it is generally accepted as reflective of the state’s geographic and economic demarcations (Maryland Marketing Partnership, 2021) and because smaller subdivisions (such as counties) would have resulted in sparse data for some regions. These regions are also differentiated by factors associated with regional variation in overdose numbers: population density, income, and EMS request for services (Forati, Ghose, & Mantsch, 2021 [ 28 ]; Haffajee et al, 2019 [ 29 ]; Monnat, 2019 [ 30 ]). Supplemental eTable 2 in S1 Appendix displays median household income and population estimates for the five regions for the 2019 calendar year.…”