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dc.contributor.authorSandoval-Olascoaga, Sebastian
dc.contributor.authorVenkataramani, Atheendar S.
dc.contributor.authorArcaya, Mariana Clair
dc.date.accessioned2021-09-03T15:15:15Z
dc.date.available2021-09-03T15:15:15Z
dc.date.issued2021-08
dc.identifier.issn2574-3805
dc.identifier.urihttps://hdl.handle.net/1721.1/131237
dc.description.abstractImportance: Housing insecurity induced by evictions may increase the risk of contracting COVID-19. Objective: 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. Exposures: Time since state-level eviction moratoria were lifted. Main Outcomes and Measures: 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. Results: 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). Conclusions and Relevance:The findings of this difference-in-differences analysis suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic.en_US
dc.publisherAmerican Medical Association (AMA)en_US
dc.relation.isversionofhttp://dx.doi.org/10.1001/jamanetworkopen.2021.29041en_US
dc.rightsCreative Commons Attribution 4.0 International licenseen_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_US
dc.sourceJAMA Network Openen_US
dc.titleEviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United Statesen_US
dc.typeArticleen_US
dc.identifier.citationSandoval-Olascoaga, Sebastian et al. "Eviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United States." JAMA Network Open 4, 8 (August 2021): e2129041. © 2021 Sandoval-Olascoaga S et al.en_US
dc.contributor.departmentMassachusetts Institute of Technology. Department of Urban Studies and Planning
dc.relation.journalJAMA Network Openen_US
dc.eprint.versionFinal published versionen_US
dc.type.urihttp://purl.org/eprint/type/JournalArticleen_US
eprint.statushttp://purl.org/eprint/status/PeerRevieweden_US
dspace.date.submission2021-09-02T13:40:00Z
mit.journal.volume4en_US
mit.journal.issue8en_US
mit.licensePUBLISHER_CC
mit.metadata.statusCompleteen_US


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