Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

Abstract

This preprint has since been peer reviewed and published in the American Journal of Epidemiology. It can be found at the following link: https://doi.org/10.1093/aje/kwab196

Background: The COVID-19 pandemic and associated economic crisis has rendered millions of U.S. households unable to pay rent, placing them at risk for eviction. Evictions may accelerate COVID-19 transmission by increasing household crowding and decreasing individuals’ ability to comply with social distancing directives. We leveraged variation in the expiration of eviction moratoriums in U.S. states to test for associations between evictions and COVID-19 incidence and mortality.

Methods: The study included 44 U.S. states that instituted eviction moratoriums., followed from March 13th to September 3rd, 2020. We modeled associations using a difference-in-difference approach with an event study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. We then used model predictions to estimate cumulative cases and deaths associated with expiring eviction moratoriums.

Findings: Twenty-seven states lifted eviction moratoriums during the study period. COVID-19 incidence in states that lifted their moratoriums was 1.6 (95% CI 1.0,2.3) times the incidence of states that maintained their moratoriums at 10 weeks post-lifting and grew to a ratio of 2.1 (CI 1.1,3.9) at ≥16 weeks. Mortality in states that lifted their moratoriums was 1.6 (CI 1.2,2.3) times the mortality of states that maintained their moratoriums at 7 weeks post-lifting and grew to a ratio of 5.4 (CI 3.1,9.3) at ≥16 weeks. These results translate to an estimated 433,700 excess cases (CI 365200,502200) and 10,700 excess deaths (CI 8900,12500) nationally.

Interpretation: Lifting eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public health rationale for use of eviction moratoriums to prevent the spread of COVID-19.

Note: This article has yet to undergo formal peer review and is being released as a preprint due to the time sensitive nature of the research.

Keywords: COVID-19; Pandemic; SARS-CoV-2; housing; health; moratoriums; moratoria; eviction; homelessness; health equity; health justice; health inequity; policy; housing instability