(WITHDRAWN) An Ecological Analysis of Family and Community Violence, Racial and Ethnic Neighborhood Composition, Poverty and Rates of Opioid Overdose Deaths in Chicago: A Call to Action with Implications for Social Work Practice and Policy

Background: The following study examined associations between rates of family and community violence, racial/ethnic composition, poverty, and opioid overdose (OD) in Chicago. This study hypothesized that neighborhoods with greater rates of family and community violence, poverty, and African American and Hispanic populations would be associated with greater rates of opioid OD after adjusting for spatial dependence in the data.

Methods: This study used data from the Cook County Medical Examiner’s Office of opioid OD death rates from 2016-2017 per 100,000 in 77 neighborhoods in Chicago. Family violence consisted of crimes that met the criteria for domestic-related offenses defined by the Illinois Domestic Violence Act. Community violence included assault, battery, homicide, and robbery. Crime data consisted of the number of reported crimes by the Chicago Police Department.

Empirical Bayes Moran’s I tests for spatial dependence identified statistically significant clusters of opioid OD deaths and rates of family and community violence, racial/ethnic composition, and poverty. Maps visualized quartiles of rates of opioid OD, family and community violence poverty, and racial and ethnic composition. Generalized spatial two-stage least squares cross-sectional regression analysis examined the association between log-transformed rates of family and community violence, racial and ethnic composition, poverty, and rates of opioid OD.

Results: The mean opioid OD death rate was 35.78 (SD=29.14) per 100,000. The mean rate of family and community violence was 186.67 (SD=163.9) and 345.25 (SD=43.37). The racial and ethnic composition of neighborhoods was 38.15% (SD=39.82) Black, 28.92% White (SD=27.34), 5.98% (SD=10.79) Asian, and 26.95% (SD=28.39) other races. Neighborhoods in the highest quartile of opioid OD rates had rates of family and community violence 5.55 (M=407.11 vs. 73.36 per 100,000) and 4.66 (M=740.57 vs. 159.03) times greater than rates of family and community violence in the lowest quartile. The mean percent in poverty was 2.04 (34.59% vs. 16.90%) times greater in the highest quartile of opioid OD deaths compared to the proportion in poverty in the lowest quartile of opioid OD death rates. The percent of the population that was Black in the highest quartile was 5.91 (86.68% vs. 14.67%) times the Black population in the lowest quartile of opioid OD rates. Significant clusters of neighborhoods were identified consisting of high rates of opioid OD mortality, family and community violence, racial and ethnic composition, and poverty. Greater rates of family (B=2.05, CI_95%=1.36, 2.78, p<.001) and community violence (B=2.27, CI_95%=1.46, 3.08, p<.001), percent African American (B=.04, CI_95%=.03, .06, p<.001), poverty (B=.14, CI_95%=.07, .20, p<.001) was associated with greater rates of opioid OD deaths.

Conclusions: Findings from this study suggest that there is associated risks between opioid OD mortality and neighborhoods with high exposure to family and community violence. This is especially the case in neighborhoods that are predominately African American. Implications for this study suggest that in order to address challenges related to opioid use/mortality, we must also address the social context that can fuel the use of opioids that may be used as a form of refuge to cope with exposure to physical, psychological, and secondary trauma.