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In the first two years of the Covid-19 pandemic, the risk of death for renters facing eviction was 2.6 times greater than it was in the general population, a new study found.
CNN  — 

Housing instability carries deadly risks, and these vulnerabilities were exacerbated for many during the Covid-19 pandemic.

The mortality rate among renters who faced eviction was twice as high as expected during the first two years of the pandemic, according to a study published on Tuesday in JAMA. The general population also experienced excess mortality during this time, but the risk started higher for renters and rose exponentially for those threatened with eviction.

From January 2020 through August 2021, the risk of death for renters facing eviction was 2.6 times greater than it was in the general population, the study found. During the baseline period of 2010 to 2016, the mortality rate was 1.4 times higher for renters facing eviction than it was for the general population.

“The pandemic has really highlighted how housing is so critical to health and public health,” said Nick Graetz, a researcher at Princeton University’s Eviction Lab and lead author of the study. “That all became really clear and salient during a pandemic where there was this massive infectious disease risk. But this deep connection between housing and health, it’s not new. It’s not going to disappear if Covid numbers come down.”

The new study is the third in a series of work from a collaboration between the Eviction Lab and the US Census Bureau, with aims to fill gaps in understanding about who faces eviction in the United States and what the impacts are.

Work published in October showed that about 7.6 million people are threatened with eviction each year, and risks are highest for households with children and Black renters. Another study from December explored the risk between rising rent costs and mortality risk.

The latest study is the first to focus on a pandemic timeframe, and the findings focus on eviction filing trends in 36 court systems that cover about 400 counties. While the findings for the new study are not nationally representative, they do show stark connection.

Data limitations prevented the researchers from identifying causes of death among renters facing eviction, but experts point to the negative effects of chronic stress as a likely driver.

“Eviction filings may represent a general state of financial strain among renters, which in turn leads to chronic stress increasing health risks and mortality,” Jack Tsai, a professor at UTHealth Houston School of Public Health and director of research for the US Department of Veterans Affairs’ National Center on Homelessness among Veterans, wrote in a related editorial.

Chronic stress is a known risk factor for many of the leading causes of death in the US during the pandemic, including heart disease, cancer and stroke, he wrote.

Many of these leading causes of death are associated with older age, but the average renter threatened with eviction during the pandemic was just 36 years old, according to the new study.

“Overwhelmingly, we should think of this as premature death in terms of what a healthy life expectancy should be in the United States, richest country in the world,” Graetz said. “Older folks are experiencing really intense housing insecurity, but we know that most (eviction) filings occur among folks around age 25 to 50, so that’s where the bulk of this excess mortality burden is going to come from.”

For advocates working to help individuals facing eviction, the toll that the process has on physical and mental health is readily apparent.

“A lot of times people talk about how that stress is impacting them. Fatigue is definitely something that sets in for a lot of people, they’re not sleeping well. And I have had multiple clients, as well, who have autoimmune diseases that report flare ups due to the stress,” said Katie Derrick, a community health worker at Jesse Tree, a social services organization focused on preventing eviction and homelessness in Boise, Idaho.

The relationship between housing insecurity and health is cyclical, Derrick said. Health issues are the second most common reason people say they apply for services at Jesse Tree.

An unexpected medical bill or missing work to care for a sick child can cause a person to fall behind on rent, she said. A negative housing situation can then lead to more negative health impacts, which then require more resources.

In addition to the chronic stress of housing instability, Tsai also notes in his editorial that “eviction filings can lead renters to move or be displaced to inferior housing environments that may increase their health risks.”

“Crowded, unsanitary, or otherwise unsafe living conditions can increase the risk of transmission of diseases like COVID-19 and others, such as tuberculosis,” he wrote. Low-quality housing can also affect a person’s health through exposure to toxins such as lead and asbestos, noise pollution and harsh weather elements.

Eviction filings were down 45% during the first two years of the pandemic, according to the new study.

But experts warn that deadly health risks may grow, as many public assistance programs that were in effect in the early years of the pandemic – such as eviction moratoriums – are ended.

“As we move out of maybe the most intense period of Covid prevalence and mortality, we return to a normal that was already untenable, and it’s been getting worse,” Graetz said. “Rent burdens are as high as they’ve ever been, and eviction filings are now back and surpassing historical averages.”

In the last quarter of 2023, more than two out of five people who applied for housing support services from Jesse Tree in Idaho had been to the emergency department, half of whom had been more than once over the course of three months, Derrick said.

“Accessing the ED for things that could be addressed with a primary care physician costs a lot more,” she said. “It’s eye-opening how inaccessible care is for folks.”

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Even for those who do have access to care, some patients may not feel comfortable raising concerns about housing with their doctor. When patients talk about struggling to afford their medications, that’s often a clue that more is going on, said Dr. Steven Furr, a family physician in Alabama and president of the American Academy of Family Physicians.

“As physicians, we’re focused on treating the whole patient and we realize that the social world in which they live is so important to their health care,” said Furr, who was not involved in the new study. “We realize that the medications and diagnoses we give them are about 20% of the issue, and where they live and where they work is about 80%. So we’re constantly asking them what kind of environment they’re in, what’s going on with their situation.”

Some Medicare programs recently started paying providers to screen patients with a social determinants of health assessment, he said, which may encourage even more focus on these issues.

On Maslow’s hierarchy of needs, shelter is grouped with air, water and food as one of the bare necessities for human survival.

“It’s one of the basic foundations that you need to build health and build employment,” Tsai told CNN. “If you don’t have that, it’s really challenging to start moving on to addressing the other social determinants of health.”