Searcharxiv⌕ Search
Home/Archive/arXiv

arXiv · 2605.08230

Social Determinants of Health and Fentanyl Overdose Mortality Across US Counties: An XGBoost and SHAP Analysis Identifying Silent Risk Counties and Treatment Deserts

Kabi Raj Tiruwa·Abhisan Ghimire·Anuj Kumar Shah
View original source ↗Read source document ↗Export metadata ↓

Abstract

Background: Fentanyl overdose deaths are still increasing across the U.S. We do not fully understand which county-level social and structural conditions lead to higher overdose death rates. Social determinants of health, including disability, treatment access, and behavioral health issues, may help identify vulnerable counties before deaths become severe. No earlier study has used explainable machine learning with SHAP attribution on 2022 CDC WONDER data to study treatment access gaps and silent risk counties. Methods: We combined data from four government sources for 975 U.S. counties, including CDC WONDER (2022) overdose mortality data, CDC Social Vulnerability Index (SVI), CDC PLACES health behavior data, and Area Health Resources Files. An XGBoost model was used to predict overdose mortality risk using Standardized Mortality Ratio (SMR). Five-fold cross-validation was used to test model accuracy, and SHAP values were used to show which factors increase or decrease risk. Results: XGBoost outperformed all tested models (Spearman rho=0.67, R2=0.457, MAE=0.409, high-risk recall=71.1%). Top predictors were disability rate, hypertension, smoking, and lack of vehicle access. Treatment desert counties had 52.6% higher overdose mortality (SMR 1.786 vs 1.170; p<0.0001). K-means identified 143 silent risk counties. Overdose deaths were spatially clustered (Moran's I=0.505, p=0.001) with 75 hotspots and 136 coldspots. Suppressed counties were 58.2% of WONDER counties, mostly rural (72%) and treatment deserts (65%). Conclusions: County-level SDOH factors predict overdose deaths, especially disability, treatment access, and behavioral health burden. MOUD expansion should prioritize treatment desert counties, and silent risk counties need early intervention before mortality worsens.

Explore related subjects

cs.LGstat.AP

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Kabi Raj Tiruwa, Abhisan Ghimire, Anuj Kumar Shah. 2026-05-06. Social Determinants of Health and Fentanyl Overdose Mortality Across US Counties: An XGBoost and SHAP Analysis Identifying Silent Risk Counties and Treatment Deserts. https://arxiv.org/abs/2605.08230

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related papers

arXiv2026

AUC Maximization from Biased Positive-unlabeled Data with Confidence

Maximizing the area under the receiver operating characteristic curve (AUC) is a standard approach to imbalanced binary classification. Although positive and negative data are required for maximizing the AUC, negative data are often difficult to collect in some real-world applications due to privacy concerns or the need for specialized expertise to annotate them. Thus, AUC maximization from positive and unlabeled (PU) data has been attracting attention. Existing methods assume that labeled positive data are unbiased samples from the true positive distribution. However, this ideal assumption is often violated in practice. In this paper, we propose a method to maximize the AUC from biased PU data. To address the bias, our key idea is to exploit {\it confidence}, i.e., the probability that an instance is positive, associated with the small number of labeled positive data. We derive an estimator of the AUC risk using biased PU data with confidence, enabling AUC maximization under such bias. We further show that the rewritten AUC risk induces a Bayes-optimal AUC ranking even when the available confidence is any strictly increasing transformation of the true posterior probability. We experimentally show the effectiveness of our method on eight real-world datasets.

cs.LG↗
arXiv2026

Measuring the Value of World-Model Updates: A Counterfactual Utility Protocol for Continual Adaptation

Continual world models must decide whether new data justify changing the model. Fixed replay schedules and prediction-error triggers specify when to update, but neither reveals the value of an individual update: one deployment run cannot show how the same model would have performed at that moment had it held its parameters. We introduce the fork ledger, which branches a deployment stream at pre-registered decision points into matched update and hold continuations under common random numbers. It evaluates both continuations on the same episodes and records $\Delta R = R_{\mathrm{update}} - R_{\mathrm{hold}}$. Always applying one fixed update mechanism lowers return on all three simulated control tasks: CartPole ($-144.0$; checkpoint-bootstrap $95\%$ CI $[-185.4,-116.1]$, against a converged return near $650$), Walker ($-82.8$; $[-101.1,-61.7]$) and Cheetah ($-18.6$; $[-29.0,-6.6]$). Divergence is an outcome of applying the update, so the estimand counts every attempted fork; restricted to the $693$ of $720$ that did not collapse, CartPole and Walker are unchanged in sign ($-113.4$ and $-82.1$) and Cheetah becomes unresolved ($-3.9$; $[-17.5,+13.0]$). The task is the unit of inference: each contributes $240$ attempted forks over five pretrained checkpoints crossed with two drift directions. The ledger makes counterfactual utility observable for a fixed mechanism, allowing triggers to be judged by the updates they select rather than by surprise detection alone.

cs.LG↗
arXiv2026

When More Is Not Better: Component Anti-Synergy in a P300 Speller

P300 brain-computer interface (BCI) spellers can provide hands-free communication for people with severe motor impairments. Modern pipelines combine multiple individually promising components, often assuming that 'more-is-better'. We tested this assumption using a four-component full-factorial experiment varying the inclusion of Euclidean Alignment (EA), xDAWN spatial filtering, subject calibration, and language model priors on a public P300 dataset. Performance was evaluated using accuracy, repetitions, and information transfer rate (ITR) with mixed-effects models. Results show that the value of components is conditional rather than additive. Calibration was the strongest singular contributor, while EA compensated for its absence in zero-calibration settings. Adding independently useful components could also reduce performance, revealing component anti-synergy. Contrary to conventional wisdom, LM support was not universally beneficial: its effect depends strongly on the strength of the underlying EEG pipeline, while results from a larger LM showed a similar pattern. Together, these findings challenge maximal 'all-on' pipeline design and highlight the value of selecting spatial and language-support components according to the quality of available EEG evidence.

cs.LG↗