Examining Excess Mortality Associated With the COVID-19 Pandemic for Renters Threatened With Eviction

Nick Graetz, Peter Hepburn, Carl Gershenson, et al

JAMA. 2024;331(7):592-600. doi:10.1001/jama.2023.27005

Key Points

Question What were the patterns of excess mortality associated with the COVID-19 pandemic among renters who received eviction filings?

Findings In this retrospective study of 282 000 renters who received an eviction filing between January 1, 2020, and August 31, 2021, an excess mortality analysis found that observed mortality was 106% higher than expected. By comparison, observed mortality among similar renters was 25% higher than expected and among the general population was 9% higher than expected.

Meaning Housing instability, as measured by eviction filings, was associated with significantly increased risk of death over the first 20 months of the COVID-19 pandemic. Eviction prevention efforts may have reduced excess mortality for renters during this period.

Abstract

Importance Residential evictions may have increased excess mortality associated with the COVID-19 pandemic.

Objective To estimate excess mortality associated with the COVID-19 pandemic for renters who received eviction filings (threatened renters).

Design, Setting, and Participants This retrospective cohort study used an excess mortality framework. Mortality based on linked eviction and death records from 2020 through 2021 was compared with projected mortality estimated from similar records from 2010 through 2016. Data from court records between January 1, 2020, and August 31, 2021, were collected via the Eviction Lab’s Eviction Tracking System. Similar data from court records between January 1, 2010, and December 31, 2016, also collected by the Eviction Lab, were used to estimate projected mortality during the pandemic. We also constructed 2 comparison groups: all individuals living in the study area and a subsample of those individuals living in high-poverty, high-filing tracts.

Exposures Eviction filing.

Main Outcomes and Measures All-cause mortality in a given month. The difference between observed mortality and projected mortality was used as a measure of excess mortality associated with the pandemic.

Results The cohort of threatened renters during the pandemic period consisted of 282 000 individuals (median age, 36 years [IQR, 28-47]). Eviction filings were 44.7% lower than expected during the study period. The composition of threatened renters by race, ethnicity, sex, and socioeconomic characteristics during the pandemic was comparable with the prepandemic composition. Expected cumulative age-standardized mortality among threatened renters during this 20-month period of the pandemic was 116.5 (95% CI, 104.0-130.3) per 100 000 person-months, and observed mortality was 238.6 (95% CI, 230.8-246.3) per 100 000 person-months or 106% higher than expected. In contrast, expected mortality for the population living in similar neighborhoods was 114.6 (95% CI, 112.1-116.8) per 100 000 person-months, and observed mortality was 142.8 (95% CI, 140.2-145.3) per 100 000 person-months or 25% higher than expected. In the general population across the study area, expected mortality was 83.5 (95% CI, 83.3-83.8) per 100 000 person-months, and observed mortality was 91.6 (95% CI, 91.4-91.8) per 100 000 person-months or 9% higher than expected. The pandemic produced positive excess mortality ratios across all age groups among threatened renters.