1. In a retrospective cohort of young children in the United States, prior eviction was associated with poorer health, increased developmental risk, and hospital admission.

2. Prior eviction was also associated with worse caregiver health and an increased risk of household hardships, including food insecurity, energy insecurity, and childcare constraints.

Evidence Rating Level: 2 (Good)

Study Rundown: Eviction has been linked to worse health outcomes for adults and children; however, there is limited information on the consequences for infants and toddlers. Using a retrospective cohort of young children recruited from pediatric clinical settings across the United States, this study investigated the association between eviction, child and caregiver health, and household-level hardships. For infants and toddlers, eviction was associated with increased odds of poor health, developmental risks, and hospital admissions. In the caregivers of these children, eviction was similarly associated with an increased odds of poor health and depressive symptoms. Additionally, eviction was associated with increased exposure to household-level hardships, notably food insecurity, energy insecurity, and childcare constraints. This study benefits from a large, national sample, as well as a self-reported measure of eviction, which captures both formal and informal processes. However, the recruitment strategy did not use random sampling, placing it at risk for selection bias, and the inability to randomize exposure to eviction prevents any direct assessment of causality. Regardless, when taken in the context of a robust literature on the importance of housing stability for health, this study adds support for the implementation of health policies that seek to prevent evictions.

Click to read the study in Pediatrics

Relevant Reading: The effects of housing insecurity on children’s health: a scoping review

In-Depth [retrospective cohort]: In this study, medical records from February 2011 to December 2019 were audited from three pediatric emergency departments and two pediatric primary care centers across the US, for children <48 months old. Household-level surveys were sent out to caregivers eligible for the study, with a response rate of 91.4%. Of those who completed surveys, homeowners and those who had missing data on eviction history were excluded, leading to an analytic sample of 26,411 caregiver-child dyads. Eviction history, demographics, caregiver-reported health, and household hardships were assessed in the surveys, while additional anthropomorphic and hospital admission data were obtained from medical records directly. The main analyses were conducted using multivariate logistic regression controlling for study site, caregiver and child demographics, insurance, breastfeeding history, number of children in the household, and low birth weight. The adjusted odds ratios were calculated for three primary dichotomous outcomes: child health (fair or poor vs. good or excellent), child developmental risks (any vs. none), and hospital admission (yes vs. no). The odds of each outcome were significantly higher for children who had experienced eviction than for children who had not (aOR = 1.43 for worse child health; aOR = 1.55 for developmental risk; aOR = 1.24 for ED admission; p<0.05 for all three). Adverse caregiver outcomes, including poorer health and depressive symptoms were also associated with prior history of eviction, as were other housing hardships and household-level hardships, like food insecurity, energy insecurity, and childcare constraints (p<0.05 for all).

Image: PD

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