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We compared these locations to a proportional sample of blocks with no 2018-2019 overdoses (New York City n\u00a0=\u00a02093; Chicago n\u00a0=\u00a01148). We used logistic regression to explore associations between block characteristics and odds of an overdose event, controlling for neighborhood-level covariates (poverty, segregation). For both cities, blocks had significantly increased odds (P\u00a0&amp;lt;\u00a0.05) of being overdose case sites if they had apartment buildings, bus stops, street trash, traffic calming features, and warning signs. New York City blocks also had significantly increased overdose odds if they had multifamily homes, commercial businesses, poor sidewalk maintenance, and loitering, and significantly decreased odds if they had single family homes, row homes, and security alarm signs. Chicago blocks with significantly increased overdose odds had vacant lots, abandoned buildings, alleys, restaurants, and adults on the street and significantly decreased odds with landscaping. Findings support neighborhood social and physical characteristics as important risk factors for fatal opioid overdose over and above sociodemographics.<\/jats:p>","DOI":"10.1093\/aje\/kwaf152","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T14:36:26Z","timestamp":1752676586000},"page":"3248-3257","source":"Crossref","is-referenced-by-count":1,"title":["Exploring modifiable neighborhood risk factors for fatal opioid overdose: a case\u2013control study in two US cities"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8562-8646","authenticated-orcid":false,"given":"Elizabeth D","family":"Nesoff","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 19104 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6522-6420","authenticated-orcid":false,"given":"Christopher","family":"Morrison","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health , New York, NY 10032 ,","place":["United States"]},{"name":"Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine , Melbourne VIC 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6434-8693","authenticated-orcid":false,"given":"Douglas J","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, MI 48109 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-9993","authenticated-orcid":false,"given":"Silvia S","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health , New York, NY 10032 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"2025112018525993900_ref1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:135849","volume-title":"Drug Overdose Deaths in the United States, 2002\u20132022. 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