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Spatial epidemiology of nonfatal overdose in a community-based cohort of marginalized women in Vancouver, British Columbia (2014–2022)

Goldenberg, Shira; Valencia, Esteban J.; Amram, Ofer; Shannon, Kate; Kielhold, Kirstin; Zhou, Charlie (Haouxan); Deering, Kathleen

2025-07-01

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Given limited data regarding the spatial epidemiology of overdose among women amid the current overdose crisis, we evaluated (1) changes in spatiotemporal clustering of overdose over time, (2) the association between residential proximity to overdose clusters and recent nonfatal overdose, and (3) the association between ‘risk environment’ features and residential proximity to overdose clusters. Questionnaire data were from a merged community-based cohort of marginalized women who use drugs in Vancouver, Canada (09/2014–08/2022). Residential proximity to overdose clusters was associated with higher odds of recent nonfatal overdose. ‘Risk environment’ features of unstable housing, unsafe sleeping environments, and physical violence were associated with elevated odds of residential proximity to overdose clusters. Marginalized women face a high and rising burden of nonfatal overdose, which is influenced by the ‘risk environments’ in which they reside. Scale-up of geographically tailored overdose prevention services, harm reduction, and programs addressing violence and housing are needed.