The spatial prevalence and associated factors of opioid overdose mortality in Milwaukee County, Wisconsin (2003-2018)

•The opioid overdose mortality rate demonstrates significant spatial autocorrelation in Milwaukee County.•The spatial lag model accounts for greater variation among social determinants of health and the opioid overdose mortality rate than the traditional ordinary least squares model.•There is a significant global spillover effect of the opioid overdose mortality rate at the census tract level, indicating that without a public health practice that is racially equitable, the opioid epidemic will never be resolved as the use and misuse of opioids continues to spillover from neglected communities into the rest of the county.•Lower socioeconomic status, indicative of structural racism, and a prevalence of labor-intensive occupations were identified as the most significant social determinants associated with fatal opioid overdose in Milwaukee County.