Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge.
OptumLabs Visiting Fellow, Eden Prairie, Minnesota.
JAMA Netw Open. 2021 Aug 2;4(8):e2129041. doi: 10.1001/jamanetworkopen.2021.29041.
Housing insecurity induced by evictions may increase the risk of contracting COVID-19.
To estimate the association of lifting state-level eviction moratoria, which increased housing insecurity during the COVID-19 pandemic, with the risk of being diagnosed with COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included individuals with commercial insurance or Medicare Advantage who lived in a state that issued an eviction moratorium and were diagnosed with COVID-19 as well as a control group comprising an equal number of randomly selected individuals in these states who were not diagnosed with COVID-19. Data were collected from OptumLabs Data Warehouse, a database of deidentified administrative claims. The study used a difference-in-differences analysis among states that implemented an eviction moratorium between March 13, 2020, and September 4, 2020.
Time since state-level eviction moratoria were lifted.
The primary outcome measure was a binary variable indicating whether an individual was diagnosed with COVID-19 for the first time in a given week with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1. The study analyzed changes in COVID-19 diagnosis before vs after a state lifted its moratorium compared with changes in states that did not lift it. For sensitivity analyses, models were reestimated on a 2% random sample of all individuals in the claims database during this period in these states.
The cohort consisted of 509 694 individuals (254 847 [50.0%] diagnosed with COVID-19; mean [SD] age, 47.0 [23.6] years; 239 056 [53.3%] men). During the study period, 43 states and the District of Columbia implemented an eviction moratorium and 7 did not. Among the states that implemented a moratorium, 26 (59.1%) lifted their moratorium before the US Centers for Disease Control and Prevention issued their national moratorium, while 18 (40.1%) maintained theirs. In a Cox difference-in-differences regression model, individuals living in a state that lifted its eviction moratorium experienced higher hazards of a COVID-19 diagnosis beginning 5 weeks after the moratorium was lifted (hazard ratio [HR], 1.39; 95% CI, 1.11-1.76; P = .004), reaching an HR of 1.83 (95% CI, 1.36-2.46; P < .001) 12 weeks after. Hazards increased in magnitude among individuals with preexisting comorbidities and those living in nonaffluent and rent-burdened areas. Individuals with a Charlson Comorbidity Index score of 3 or greater had an HR of 2.37 (95% CI, 1.67-3.36; P < .001) at the end of the study period. Those living in nonaffluent areas had an HR of 2.14 (95% CI, 1.51-3.05; P < .001), while those living in areas with a high rent burden had an HR of 2.31 (95% CI, 1.64-3.26; P < .001).
The findings of this difference-in-differences analysis suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic.
驱逐导致的住房无保障可能会增加感染 COVID-19 的风险。
评估解除州级驱逐禁令（在 COVID-19 大流行期间增加住房无保障）与被诊断患有 COVID-19 的风险之间的关联。
设计、地点和参与者：这是一项回顾性队列研究，包括有商业保险或 Medicare Advantage 的个人，这些人居住在发布驱逐禁令的州，并且被诊断患有 COVID-19，以及一个对照组，由这些州中相同数量的随机选择的未被诊断患有 COVID-19 的个体组成。数据来自 OptumLabs 数据仓库，这是一个匿名行政索赔数据库。该研究使用了在 2020 年 3 月 13 日至 2020 年 9 月 4 日期间实施驱逐禁令的州之间的差异差异分析。
自州级驱逐禁令解除以来的时间。
主要结果是一个二值变量，表示个体在给定周内是否首次被诊断出患有 COVID-19，采用国际疾病分类第十版代码 U07.1。该研究分析了与未解除禁令的州相比，州解除禁令前后 COVID-19 诊断的变化。作为敏感性分析，在该时期该州所有个体的 2%随机样本上重新估计了模型。
队列包括 509694 名个体（254847 [50.0%] 被诊断患有 COVID-19；平均[标准差]年龄，47.0[23.6]岁；239056 [53.3%] 为男性）。在研究期间，43 个州和哥伦比亚特区实施了驱逐禁令，7 个州没有。在实施禁令的州中，26 个（59.1%）在疾病预防控制中心发布全国禁令之前解除了禁令，而 18 个（40.1%）维持了禁令。在 Cox 差异差异回归模型中，居住在解除驱逐禁令的州的个体在禁令解除后 5 周开始出现 COVID-19 诊断的风险更高（风险比[HR]，1.39；95%置信区间[CI]，1.11-1.76；P=0.004），12 周后达到 HR 为 1.83（95%CI，1.36-2.46；P<0.001）。在有预先存在的合并症的个体和居住在非富裕和租金负担重的地区的个体中，风险增加。Charlson 合并症指数评分为 3 或更高的个体在研究期末的 HR 为 2.37（95%CI，1.67-3.36；P<0.001）。居住在非富裕地区的个体的 HR 为 2.14（95%CI，1.51-3.05；P<0.001），而居住在租金负担沉重地区的个体的 HR 为 2.31（95%CI，1.64-3.26；P<0.001）。
这项差异差异分析的结果表明，驱逐导致的住房无保障可能加剧了 COVID-19 大流行。
