Association between eviction and child health outcomes

Association between eviction and child health outcomes | Image Credit: © Alexis Scholtz/peopleimages.com - © Alexis Scholtz/peopleimages.com - stock.adobe.com.

Efforts to prevent eviction may improve infant and child health outcomes, according to a recent review published in JAMA Network Open.

Child health is significantly impacted by housing conditions, with various health conditions observed in children experiencing multiple moves or homelessness. These include respiratory conditions, mental illnesses, and infections.

Over 2 million eviction filings occur in the United States annually, resulting in almost 1 million completed evictions. Eviction risk is even greater in Black and Hispanic women and children because of racial and ethnic income and wealth inequality.

Prenatal and early life stress have been linked to pediatric mental health problems, and prenatal stress is also associated with adverse birth outcomes such as preterm birth. Relationships between parents and children may also be strained from economic hardships linked to evictions. Therefore, eviction may lead to harmful effects on child development.

To determine adverse infant and child outcomes associated with eviction, investigators conducted a systematic review. Studies were gathered through searches on electronic databases such as PubMed, Web of Science, and PsycINFO, with studies from the databases’ inception through September 25, 2022, included in the analysis.

Articles were included if they had at least 1 outcome, evaluated patients aged under 18 years, were quantitative analyses, and limited the exposure to direct or neighborhood-level eviction. Child health outcomes included mental health, physical health, birth outcomes, cognitive outcomes, health behaviors, health care access, and health care utilization.

Studies were assessed by 2 independent researchers based on titles and abstracts, while data extraction was done by 3 independent researchers. Extracted data included study design, sample size, location, recruitment strategy, participant demographics, eviction measures, health outcomes, statistical methods, and results.

Studies were placed into a birth outcomes group or a later health outcomes group. A score system adapted from the Newcastle-Ottawa scale was used to assess evidence quality, with studies rated by 3 independent investigators.

Criteria for rating studies included representativeness of evicted cohort, recruitment of a comparable noneviction cohort, no health outcome at start of study, adequacy of methods to reduce confounding, proper measurement of the outcome, and adequacy of addressing bias.

There were 11 studies included in the final analysis, 10 of which were published after 2020. Multistate or national samples were analyzed in 5 studies, 3 used a longitudinal design, 2 were cross-sectional, and 1 used an ecological design. 

The median sample size in a study was 19,096 participants, with samples ranging from 1386 to 7,324,812 participants. Birth outcomes were assessed in 6 studies, while 5 assessed cognitive or neurodevelopmental outcomes, parent-reported general child health, weight, and lead testing.

Associations between eviction and birth outcomes were analyzed in 6 studies. Outcomes measured included gestational age, preterm birth, small for gestational age, low birthweight, placental lesions, and infant mortality.

A significant association between eviction and at least 1 adverse birth outcome was found in all 6 studies. In 1 study, eviction during pregnancy was associated with increased risk of preterm birth, shorter gestation, and low birthweight. Five studies analyzing neighborhood eviction found higher rates of preterm birth and low birthweight in regions with higher eviction rates.

Associations between eviction and child health outcomes were analyzed in 5 studies, 3 of which included a cohort with a high proportion of Black, Hispanic, and low-income families. Worse child health status in children aged 5 years, reported by mothers, was associated with recent eviction.

One study associated eviction in the prior year with lower scores on working memory, math, and vocabulary tests in children aged 9 years. Another study found an association between maternal eviction in the past 5 years and child developmental risk.

All studies showed strong quality of evidence, indicating worse outcomes after evictions. Investigators recommended policies to prevent eviction be implemented to reduce these effects.

Reference

Ramphal B, Keen R, Okuzuno SS, Ojogho D, Slopen N. Evictions and infant and child health outcomes: asystematic review. JAMA Netw Open. 2023;6(4):e237612. doi:10.1001/jamanetworkopen.2023.7612