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The COVID-19 pandemic and associated economic crisis have placed millions of U.S. households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals’ ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in U.S. states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 U.S. states that instituted eviction moratoriums, followed from March 13th to September 3rd, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative-binomial-regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and were associated with doubling of COVID-19 incidence (incidence rate ratio 2.1; 95% confidence interval (CI) 1.1,3.9) and a five-fold increase in COVID-19 mortality (mortality rate ratio 5.4; CI 3.1,9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI 365200, 502200) and 10,700 excess deaths (CI 8900,12500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.

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IMPORTANCEAlthough evictions have been associated with adverse mental health outcomes, it remains unclear which stages of the eviction process are associated with mental distress among renters. Variation in COVID-19 pandemic eviction protections across US states enables identification of intervention targets within the eviction process to improve renters' mental health. OBJECTIVETo measure the association between the strength of eviction protections (ie, stages blocked by eviction moratoriums) and mental distress among renters during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cohort study used individual-level, nationallyrepresentative data from the Understanding Coronavirus in America Survey to measure associations between state eviction moratorium protections and mental distress. The sample of 2317 respondents included renters with annual household incomes less than $75 000 who reported a state of residence and completed surveys between March 10 and September 3, 2020, prior to the federal eviction moratorium order by the Centers for Disease Control and Prevention.EXPOSURES Time-varying strength of state moratorium protections as a categorical variable: none, weak (blocking court hearings, judgments, or enforcement without blocking notice or filing), or strong (blocking all stages of the eviction process beginning with notice and filing). MAIN OUTCOMES AND MEASURESModerate to severe mental distress was measured using the 4-item Patient Health Questionnaire. Linear regression models were adjusted for time-varying state COVID-19 incidence and mortality, public health restrictions, and unemployment rates. Models included individual and time fixed effects as well as clustered standard errors. RESULTSThe sample consisted of 2317 individuals (20 853 total observations) composed largely (1788 [78%] weighted) of middle-aged adults (25-64 years of age) and women (1538 [60%]); 640 respondents (23%) self-reported as Hispanic or Latinx, 314 respondents (20%) as non-Hispanic Black, and 1071 respondents (48%) as non-Hispanic White race and ethnicity. Relative to no statelevel eviction moratorium protections, strong protections were associated with a 12.6% relative reduction (risk ratio, 0.87; 95% CI, 0.76-0.99) in the probability of mental distress, whereas weak protections were not associated with a statistically significant reduction (risk ratio, 0.96; 95% CI, 0.86-1.06). CONCLUSIONS AND RELEVANCE This analysis of the Understanding Coronavirus in AmericaSurvey data found that strong eviction moratoriums were associated with protection against mental distress, suggesting that distress begins early in the eviction process with notice and filing. This (continued)