Substance Use
Examining Neighborhood-Level Renter Cost Burden and Opioid-Involved Overdose Fatalities in Chicago, IL, 2015-2023 Morgan Watson* Morgan Watson Watson Watson Watson University of Pennsylvania
Background: Housing insecurity, including homelessness and eviction, is linked to higher fatal overdose risk. However, the relationship between renter cost burden and fatal opioid-involved overdose remains unclear. This study examined the neighborhood-level association between renter cost burden and fatal opioid-involved overdose in an urban setting.
Methods: We conducted a cross-sectional spatial analysis of Chicago census tracts using locations of opioid-involved fatal overdoses from the Cook County Medical Examiner’s Office, 2015-2023 (n = 7,926). Renter cost burden (percentage of renter households spending ≥ 30% of income on housing) and severe renter cost burden (≥ 50%) were obtained for Chicago census tracts from the American Community Survey. We mapped spatial patterns of renter cost burden and fatal overdose and assessed spatial autocorrelation using bivariate Global Moran’s I plots. We used negative binomial regression to estimate the association between renter cost burden and severe cost burden and fatal overdose rate by year, controlling for neighborhood variables (e.g., income, segregation, population density).
Results: Our findings demonstrate positive spatial autocorrelation, indicating spatial clustering of census tracts with a high proportion of cost-burdened renters and fatal overdose rates. We found consistent positive associations between fatal overdose rates and renter cost burden and severe cost burden over time, controlling for neighborhood demographics. For example, in 2023, each 10% increase in the proportion of cost-burdened renters was associated with a 9% increase in fatal overdose rate (aIRR = 1.09, 95% CI [1.02, 1.17]).
Conclusions: Neighborhoods with higher proportions of cost-burdened renter households experience higher fatal overdose rates, with consistent associations over time. Upstream housing interventions (e.g., rental assistance) may mitigate fatal overdose risk.
