AIM To identify associations between opioid-related mortality and neighborhood-level risk factors. DESIGN Cross-sectional study. SETTING Massachusetts, USA. PARTICIPANTS Using 2011-2014 Massachusetts death certificate data, we identified opioid-related (n=3,089) and non-opioid-related premature deaths (n=8,729). MEASUREMENTS The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment, and (4) health related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status, and nativity. The primary outcome of interest was opioid-related mortality. FINDINGS Multilevel models identified number of social associations per 10,000 (OR=0.84, p=0.002, 95% CI=0.75-0.94) and number of hospital beds per 10,000 (OR=0.78, p<0.001, 95%CI=0.68-0.88) to be inversely associated with opioid-related mortality, whereas percent living in poverty (OR=1.01, p=0.008, 95% CI=1.00-1.01), food insecurity rate (OR=1.21, p=0.002, 95%CI=1.07-1.37), number of federally qualified health centers (OR= 1.02, p=0.028, 95%CI=1.02-1.08), and per capita morphine milligram equivalents of hydromorphone (OR=1.05, p=0.003, 95%CI=1.01-1.08) were positively associated with opioid-related mortality. CONCLUSIONS Opioid-related deaths between 2011-2014 in the state of Massachusetts appear to be positively associated with percent living in poverty, food insecurity rate, number of federally qualified health centers, and per capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10,000 and number of hospital beds per 10,000.

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社区层面因素与阿片类药物相关死亡率之间的关联：使用死亡证明数据的多层次分析

目的 确定阿片类药物相关死亡率与社区级风险因素之间的关联。设计横断面研究。设置美国马萨诸塞州。参与者使用 2011-2014 年马萨诸塞州死亡证明数据，我们确定了阿片类药物相关 (n=3,089) 和非阿片类药物相关的过早死亡 (n=8,729)。测量 自变量包括四组社区层面的因素：(1) 心理社会因素，(2) 经济因素，(3) 建筑环境，以及 (4) 健康相关因素。在个人层面，我们包括以下构成因素：死亡年龄、性别、种族/民族、婚姻状况、教育、退伍军人身份和出生。感兴趣的主要结果是阿片类药物相关的死亡率。发现 多层次模型确定了每 10,000 人中的社会关联数（OR=0.84，p=0.002，95% CI=0.75-0。94) 和每 10,000 人的病床数量 (OR=0.78, p<0.001, 95%CI=0.68-0.88) 与阿片类药物相关死亡率呈负相关，而生活贫困百分比 (OR=1.01, p=0.008, 95% CI=1.00-1.01）、粮食不安全率（OR=1.21、p=0.002、95%CI=1.07-1.37）、联邦合格医疗中心的数量（OR=1.02、p=0.028、95%CI=1.02 -1.08) 和人均吗啡毫克当量氢吗啡酮 (OR=1.05, p=0.003, 95%CI=1.01-1.08) 与阿片类药物相关死亡率呈正相关。结论 马萨诸塞州 2011 年至 2014 年期间与阿片类药物相关的死亡似乎与生活贫困百分比、粮食不安全率、联邦合格卫生中心的数量和人均吗啡毫克当量氢吗啡酮呈正相关，但与数量呈负相关每 10 个社会协会，