To identify associations between opioid-related mortality and neighborhood-level risk factors.
Cross-sectional study.
Massachusetts, USA.
Using 2011-2014 Massachusetts death certificate data, we identified opioid-related (n=3,089) and non-opioid-related premature deaths (n=8,729).
The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment, and (4) health related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status, and nativity. The primary outcome of interest was opioid-related mortality.
Multilevel models identified number of social associations per 10,000 (OR=0.84, p=0.002, 95% CI=0.75-0.94) and number of hospital beds per 10,000 (OR=0.78, p<0.001, 95%CI=0.68-0.88) to be inversely associated with opioid-related mortality, whereas percent living in poverty (OR=1.01, p=0.008, 95% CI=1.00-1.01), food insecurity rate (OR=1.21, p=0.002, 95%CI=1.07-1.37), number of federally qualified health centers (OR= 1.02, p=0.028, 95%CI=1.02-1.08), and per capita morphine milligram equivalents of hydromorphone (OR=1.05, p=0.003, 95%CI=1.01-1.08) were positively associated with opioid-related mortality.
Opioid-related deaths between 2011-2014 in the state of Massachusetts appear to be positively associated with percent living in poverty, food insecurity rate, number of federally qualified health centers, and per capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10,000 and number of hospital beds per 10,000.

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