An assessment of overdose mortality risk across the urban–rural continuum: Integrating 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 quantify the environmental and structural features that shape overdose risk at varying geographic scales. We conducted a retrospective ecological study to examine fatal opioid overdoses across census block groups in Cook County, Illinois, from 2020 to 2023. Urbanicity was determined based on the Global Human Settlement Layer Model (GHSL-MOD), with satellite data used to derive metrics of built-up intensity, vegetative greenness, and nighttime light emissions. Environmental indicators were combined with census-based measures of neighborhood deprivation to characterize spatial variation in physical and social conditions. A Bayesian spatiotemporal model estimated neighborhood-level overdose risk, accounting for spatial dependence, temporal trends, and environmental exposures. 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. Nighttime light intensity 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.