LATEBREAKER
Substance Use
Evaluating the effect of lifting COVID-19 eviction moratoria on drug overdose death rates: an implementation of targeted learning through a modified treatment policies approach Ariadne Rivera Aguirre* Ariadne Rivera Aguirre Giselle Routhier Ivan Diaz Kelly Doran Magdalena Cerda
During the first two years of the COVID-19 pandemic, the US witnessed 207,315 avoidable drug overdose deaths. Higher eviction rates have been associated with higher drug overdose deaths. In light of the economic turmoil caused by the pandemic, and the subsequent increased risk of eviction, 43 states and the District of Columbia implemented temporary eviction moratoria. Many of these protective measures expired between April 2020 and December 2021, leaving vulnerable households at risk of eviction. The effects of these temporary housing interventions on drug overdoses remain unexplored.
We evaluated if the expiration of state eviction moratoria was associated with higher county overdose death rates from April 2020–December 2021 in the US. We obtained mortality data from NCHS and eviction moratoria dates from the COVID-19 US State Policy Database. Additionally, we compiled a range of baseline and time-varying public health, social, economic, and policy data at the county and state level. We addressed positivity violations and time-varying confounding in this volatile period stemming from the evolution of the pandemic, using a modified treatment policies algorithm. This involved implementing a targeted minimum loss-based estimation with SuperLearner on longitudinal data to estimate the average treatment effect (ATE) and the effect of a modified treatment policy of maintaining eviction moratoria an additional month. Lastly, we accounted for clustering by estimating a state-level exposure model.
Results suggest that the ATE of lifting eviction moratoria on monthly overdose deaths is 0.2 additional deaths per 100,000 people (95%CI: 0.13, 0.27). A 1-month delay lifting moratoria could have decreased monthly deaths by 0.19 per 100,000 people (95%CI: -0.33, -0.04). These findings imply that even temporary housing measures can help curb the current overdose epidemic.