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To abate the harms of opioid misuse, understanding its prevalence at the local level is crucial for stakeholders in communities to develop response strategies that effectively use limited resources. Although there exist several state\u2010specific studies that provide county\u2010level prevalence estimates, such estimates are not widely available across the country, as the datasets used in these studies are not always readily available in other states, which, therefore, has limited the wider applications of existing models. To fill this gap, we propose a Bayesian multi\u2010state data integration approach that fully utilizes publicly available data sources to estimate county\u2010level opioid misuse prevalence for all counties in the US. The hierarchical structure jointly models opioid misuse prevalence and overdose death outcomes, leverages existing county\u2010level prevalence estimates in limited states and state\u2010level estimates from national surveys, and accounts for heterogeneity across counties and states with counties' covariates and mixed effects. Furthermore, our parsimonious and generalizable modeling framework employs horseshoe+ prior to flexibly shrink coefficients and prevent overfitting, ensuring adaptability as new county\u2010level prevalence data in additional states become available. Using real\u2010world data, our model shows high estimation accuracy through cross\u2010validation and provides nationwide county\u2010level estimates of opioid misuse for the first time.<\/jats:p>","DOI":"10.1002\/sim.70707","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:17:10Z","timestamp":1788419830000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Bayesian Multi\u2010State Data Integration Approach for Estimating County\u2010Level Prevalence of Opioid Misuse in the United States"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2334-2903","authenticated-orcid":false,"given":"Zixuan","family":"Feng","sequence":"first","affiliation":[{"name":"The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering The Pennsylvania State University  University Park Pennsylvania 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University  University Park Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2024.100813"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/NOR.0000000000000521"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.1262"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.01.010"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000717"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108350"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7015a1"},{"key":"e_1_2_10_9_1","unstructured":"A.Aboulenein \u201cOpioid Crisis Cost US Nearly $1.5 Trillion in 2020\u2014Congressional Report \u201d2022 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