Declining Opioid Overdose Mortality in Chicago: Hyperlocal Differences by Socioeconomic Deprivation and Racial/Ethnic Composition.

OBJECTIVE: Opioid overdose mortality rates declined in Chicago between 2023 and 2024. This study examined differential reductions in opioid overdose mortality across Chicago community areas by neighborhood socioeconomic deprivation and racial/ethnic composition. METHODS: Opioid overdose deaths were obtained from the Cook County Medical Examiner and geocoded to Chicago's 77 community areas. Five-year average Area Deprivation Index (ADI) scores were used to characterize community-level socioeconomic disadvantage. Changes in opioid overdose mortality rates between 2023 and 2024 were assessed using multivariable linear regression and spatial analysis. RESULTS: Between 2023 and 2024, opioid overdose mortality rates declined in 57 of 77 Chicago community areas, though the size of reductions varied. Communities with the bottom 25th percentile ADI, compared with the 2nd quartile ADI, had a greater % reduction in opioid overdose mortality rates between 2023 and 2024. Additionally, communities with a higher % Black (β = 1.23, p = 0.03) and % Hispanic residents (β = 1.40, p = 0.01) were associated with a greater % reduction in the mortality rates (F(3,72) = 1.73, R2 = 0.12). However, controlling for ADI quartile and the opioid mortality rate for 2023, % Black was marginally significant. Greater declines occurred predominantly on the West and North sides of the city. CONCLUSIONS: Despite an overall decline in opioid overdose deaths in Chicago, not all community areas benefited equally. Findings highlight that opioid response efforts targeting geographic areas with a greater impact of opioid misuse, as well as community deprivation, are needed to ensure that continued progress translates into more equitable reductions in opioid overdose mortality across Chicago.