BACKGROUND: Disparities in nonmedical opioid (NMO) mortality reflect a shifting geography of risk that presents urgent public health challenges. This study uses a socio-built environment (SBE) framework to investigate how place-based conditions shape NMO-related risks across urban, suburban, and rural municipalities in New Jersey.
METHODS: Six SBE domains with multiple indicators were analyzed. Generalized linear models with a negative binomial distribution examined associations with NMO mortality, estimating incidence rate ratios with 95% confidence intervals. Domain-level contributions were assessed using log-likelihood ratio chi-square tests, with models stratified by geographies.
RESULTS: The quality of residential, commercial, and community economic engagement domains contributed significantly to NMO mortality across all municipalities. The physical environment, community participation, and spatial access to opioid health programs domains were more influential in urban settings, with weaker or inconsistent effects in suburban and rural areas. Foreclosure rates, vacant storefronts, liquor license density, and indicators of economic distress were positively associated with mortality risk, while housing stability, business density, and higher per capita income were protective. Suburban and rural municipalities showed the largest disparities in mortality risk, with distances to naloxone sites nearly eight times greater than in urban areas (IRR = 7.88, p = 0.003). Urban municipalities benefited from closer proximity to syringe access programs, which was associated with reduced mortality risk (IRR = 0.92, p = 0.011).
CONCLUSION: Disparities in NMO mortality are shaped by SBEs that vary across urban, suburban, and rural municipalities. Housing instability, economic distress, and spatial access gaps in opioid health programs consistently contributed to elevated mortality, while stronger local economies and more stable housing were protective. These findings underscore that the risk of overdose mortality emerges through place-based conditions and call for strategies responsive to local SBEs, expanding affordable housing, strengthening community economies, and improving spatial access to harm reduction and treatment services across diverse geographic settings, as demonstrated in New Jersey.
The geography of risk: Understanding disparities in nonmedical opioid mortality and the role of socio-built environments in New Jersey
Harm Reduction Journal [Epub 2026 Feb 21]. doi: 10.1186/s12954-025-01332-7.