U.S. counties with more evictions have higher mortality rates, study finds

Mortality rates are higher in U.S. counties where eviction rates are also elevated, and this trend is strongest in areas with higher proportions of Black residents and women, UT Southwestern researchers found.

"This is the first U.S. study to evaluate and identify a link between county eviction rates and mortality rates," said Andrew Sumarsono, M.D., Assistant Professor of Internal Medicine at UT Southwestern and corresponding author of the report, published in the Journal of General Internal Medicine.

Housing instability is a key social determinant of health. Eviction rates have increased over the past two decades, disproportionately affecting minorities and women in the United States, and have been shown to lead to poor health outcomes such as psychosocial stress and adverse maternal and fetal health. But the association with mortality has not been documented.

To determine if there is a link between evictions and mortality, Dr. Sumarsono's team evaluated the rates of evictions and mortality in 686 counties with available data from 2016.

Researchers found a striking relationship between county-level evictions and all-cause mortality, even after adjusting for sociodemographic factors such as age, sex, and race, as well as health factors including diabetes, hypertension, and kidney disease.

The strongest associations between eviction rates and mortality were in counties with the highest proportions of Black and female residents. For example, in counties where the proportion of women was above the median, mortality rates were five times higher than in counties with a lower proportion of women. However, the researchers cautioned that the findings may be limited in relation to Black residents since the 2016 county data on evictions captured only a quarter of the U.S., and only 2% of the residents were Black.

Regardless, the research reinforces the connection between housing and health and highlights the impact on communities with higher proportions of women and Black residents, explained Dr. Sumarsono. This issue was magnified during the COVID-19 pandemic, when a federal eviction moratorium was enacted to protect renters who lost jobs.

Affordable, stable housing is a public health concern. If you're worried about where you're going to live next week, caring about your health can easily become a lesser priority. Policies that increase affordable housing and cushion against life events that lead to housing instability could translate to better health outcomes."

Dr. Andrew Sumarsono, M.D., Assistant Professor of Internal Medicine at UT Southwestern

Utibe R. Essien, M.D., of the University of Pittsburgh School of Medicine and one of the contributing researchers on the study, said: "As wealth differences persist in the U.S., housing insecurity will remain a critical social determinant of health. Our findings show just how urgent it is to develop policies that strengthen access to housing and reduce punitive eviction practices."

Other UTSW researchers who contributed to this work include Shreya Rao, Bhumika Maddineni, Sandeep R. Das, and Ambarish Pandey.