{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:18:39Z","timestamp":1788790719552,"version":"build-2803163510"},"reference-count":53,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Office of the Director of the National Institutes of Health","award":["DP5OD026429"],"award-info":[{"award-number":["DP5OD026429"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,2,2]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the association between population size, population growth and opioid overdose deaths\u2014overall and by type of opioid\u2014in US commuting zones (CZs) in three periods between 2005 and 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>741 CZs covering the entirety of the US CZs are aggregations of counties based on commuting patterns that reflect local economies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We used mortality data at the county level from 2005 to 2017 from the National Center for Health Statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>Opioid overdose deaths were defined using underlying and contributory causes of death codes from the International Classification of Diseases, 10th revision (ICD-10). We used the underlying cause of death to identify all drug poisoning deaths. Contributory cause of death was used to classify opioid overdose deaths according to the three major types of opioid, that is, prescription opioids, heroin and synthetic opioids other than methadone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Opioid overdose deaths were disproportionally higher in largely populated CZs. A CZ with 1.0% larger population had 1.10%, 1.10%, and 1.16% higher opioid death count in 2005\u20132009, 2010\u20132014, and 2015\u20132017, respectively. This pattern was largely driven by a high number of deaths involving heroin and synthetic opioids, particularly in 2015\u20132017. Population growth over time was associated with lower age-adjusted opioid overdose mortality rate: a 1.0% increase in population over time was associated with 1.4% (95% CI: \u22122.8% to 0.1%), 4.5% (95% CI: \u22125.8% to \u22123.2%), and 1.2% (95% CI: \u22124.2% to 1.8%) lower opioid overdose mortality in 2005\u20132009, 2010\u20132014, and 2015\u20132017, respectively. The association between positive population growth and lower opioid mortality rates was stronger in larger CZs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Opioid overdose mortality in the USA was disproportionately higher in mid-sized and large CZs, particularly those affected by declines in population over time, regardless of the region where they are located.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-048831","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T11:05:19Z","timestamp":1646305519000},"page":"e048831","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Urban scaling of opioid overdose deaths in the USA: a cross-sectional study in three periods between 2005 and 2017"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4758-3875","authenticated-orcid":false,"given":"Pricila H","family":"Mullachery","sequence":"first","affiliation":[{"name":"Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Lankenau","sequence":"additional","affiliation":[{"name":"Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana V","family":"Diez Roux","sequence":"additional","affiliation":[{"name":"Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA"},{"name":"Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Li","sequence":"additional","affiliation":[{"name":"Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie Mae","family":"Henson","sequence":"additional","affiliation":[{"name":"Dornsife School of Public Health, Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9868-7773","authenticated-orcid":false,"given":"Usama","family":"Bilal","sequence":"additional","affiliation":[{"name":"Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA"},{"name":"Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"2025121600521132000_12.3.e048831.1","doi-asserted-by":"crossref","DOI":"10.1126\/science.aau1184","article-title":"Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016","volume":"361","author":"Jalal","year":"2018","journal-title":"Science"},{"key":"2025121600521132000_12.3.e048831.2","unstructured":"CDC\/National Center of Health Statistics . 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