Eviction, Post-Traumatic Stress, and Emergency Department Use Among Low-Income Individuals in New Haven, Connecticut

We sought to examine whether and how landlord-related forced moves (inclusive of, but not limited to, legal eviction) influenced emergency department (ED) use over time. We used survey data collected between 2017-2019 among 283 low-income participants in New Haven, CT to examine whether experiencing a legal eviction or other landlord-related forced move (T0) was associated with increased odds of ED use 6 months (T1) and 12 months (T2) later. We conducted bootstrapped mediation analyses to examine indirect effects of post-traumatic stress symptoms. One-fifth of participants (n=61) reported a recent forced move at baseline (T0), half of these were legally evicted. Landlord-related forced moves were associated with ED use at T1 (AOR=2.06, 95% CI:1.04-4.06) and T2 (AOR=3.05, 95% CI:1.59-5.88). After adjustment for sociodemographic factors and other health-related confounders, legal eviction was not significantly associated with ED use at T1 (AOR=1.61, 95% CI:0.68-3.81), but was significantly associated with ED use at T2 (AOR=3.58, 95% CI:1.58-8.10). Post-traumatic stress symptoms accounted for 15.1% of forced moves’ effect on ED use (p=0.05). Landlord-related forced moves are positively associated with subsequent ED use, and post-traumatic stress symptoms help explain this association. Structural interventions that promote housing stability are needed to advance health equity, and they may also reduce preventable ED use. Such interventions are imperative in the context of the COVID-19 pandemic, which has strained health system capacity and exacerbated housing instability for many low-income renters. Results underscore the relevance of trauma-informed care and integrated care management to clinical practice in emergency department settings.