Exploring modifiable neighborhood risk factors for fatal opioid overdose: A case-control study in two US cities.

To explore associations between physical and social neighborhood factors and fatal opioid overdose, we remotely visited 2018-2019 fatal opioid overdose locations in New York City (n=2867) and Chicago (n=1677) via Google Street View and used a reliable and valid tool to assess 65 street block characteristics. We compared these locations to a proportional sample of blocks with no 2018-2019 overdoses (New York City n=2093; Chicago n=1148). We used logistic regression to explore associations between block characteristics and odds of an overdose event, controlling for neighborhood-level covariates (poverty, segregation). For both cities, blocks had significantly increased odds (p<0.05) of being overdose case sites if they had apartment buildings, bus stops, street trash, traffic calming features, and warning signs. New York City blocks also had significantly increased overdose odds if they had multifamily homes, commercial businesses, poor sidewalk maintenance, and loitering, and significantly decreased odds if they had single family homes, row homes, and security alarm signs. Chicago blocks with significantly increased overdose odds had vacant lots, abandoned buildings, alleys, restaurants, and adults on the street and significantly decreased odds with landscaping. Findings support neighborhood social and physical characteristics as important risk factors for fatal opioid overdose over and above sociodemographics.