Understanding neighborhood effects of eviction on cardiovascular health

Patrick Dunn Smith

doi:10.17918/00011090

Introduction: Each year, millions of U.S. renters face a threat of eviction, with structurally marginalized groups facing the highest incidence. Past research has demonstrated that eviction, as an individual or ecological exposure, is associated with a wide array of adverse health outcomes. However, critical gaps remain in understanding how eviction influences the development and management of highly prevalent stress-related chronic diseases, such as cardiovascular disease (CVD). Using data from a national panel survey, a local cohort study, and qualitative interviews among adults in New Haven, CT, this dissertation examines the relationship between eviction and several outcomes pertinent to the development and/or management of CVD. Methods: In Aim 1, I linked tract-level eviction rates from the Eviction Lab to individual health data from the Medical Expenditure Panel Survey (MEPS; Panel 21), and used generalized estimating equations (GEE), adjusted for individual and tract-level confounders, to assess whether eviction filing or judgment rates were associated with increased odds of CVD-related hospitalizations. In Aim 2, I merged data on neighborhood eviction exposures with individual-level housing and health-related data from 372 participants in the Justice, Housing, and Health Survey, a longitudinal cohort study in New Haven, CT. I then used GEE models to estimate associations between eviction and key CVD risk or protective factors: smoking, psychological distress, ambulatory care use, and perceived social support. In Aim 3, I drew on in-depth interviews with 14 adults living with at least one chronic disease (CVD, hypertension, or diabetes) who had personally experienced eviction or lived in a high-eviction neighborhood. Analysis explored the contexts of participants' eviction experiences and the pathways through which eviction influenced their health. Results: In Aim 1, neither neighborhood eviction filing nor judgment rates were significantly associated with the odds of CVD-related hospitalization (aOR for filing rate = 0.98; 95% CI: 0.95, 1.01). Aim 2 found that higher neighborhood eviction rates were significantly associated with increased odds of moderate to severe nicotine dependence (e.g., aOR for judgment rate = 1.21; 95% CI: 1.04, 1.42), but no significant associations were observed for psychological distress, social support, or healthcare use. Aim 3 documents how eviction exposures disrupted participants' chronic disease management through varied pathways, including mental health deterioration, sleep loss, substance use, changes to health maintenance habits, or other neighborhood-level effects. While social support served as a buffer for some, the threat of eviction remained a significant source of stress and instability for many. Conclusion: This mixed-methods dissertation contributes new insights into the complex and multidimensional relationship between eviction and health. Although quantitative analyses produced mixed findings, qualitative data demonstrate how personal and neighborhood-level eviction exposures may act as a destabilizing force, compromising health management and overall well-being. Together, the findings support a growing consensus that eviction is a significant social determinant of health in need of focused attention. Future research should build upon these findings, using longitudinal designs and in-depth qualitative approaches to examine how individual and contextual eviction exposures influence health over time. In consideration of the broader literature on eviction and health, policy and practice-related efforts are needed to advance health equity and improve population health.

Understanding neighborhood effects of eviction on cardiovascular health

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Understanding neighborhood effects of eviction on cardiovascular health

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