Does Housing Eviction Modify the Effects of Alcohol Outlet Density on Hospitalizations for Assault and Alcohol Use...

Examining how the relationship between alcohol outlet density and alcohol-related harms may vary by neighborhood-level factors is important for informing the evaluation and implementation of environmental alcohol interventions and identifying other community conditions that can be modified to reduce alcohol-related harms and inequities. This study aims to extend prior research by testing whether housing eviction-a cause of housing insecurity and neighborhood destabilization-modifies the impact of alcohol outlet density on hospitalizations for assault and alcohol use disorder (AUD) in Pennsylvania ZIP codes.

We used Bayesian hierarchical space-time misalignment models to examine the associations between inpatient assault and AUD hospitalizations and housing eviction filing rates, alcohol outlet density, and the proportion of outlets selling alcohol for off-premise consumption at the ZIP code level in Pennsylvania 2018-2022 (n = 7257 space-time units), reporting relative rates (RR) and 95% credible intervals (CIs). We tested whether eviction filing rates modified the associations between outlet density/the proportion of off-premise outlets and hospitalizations for AUD and assault.

In main effects models, a one percent increase in the eviction filing rate was associated with a 1.2% increase in AUD hospitalizations (95% CI: 1.01, 1.015) and a 1.9% increase in assault hospitalizations (95% CI: 1.002, 1.038). The addition of one outlet per square mile was associated with a 0.3% increase in AUD hospitalizations (95% CI: 1.002, 1.004) and a 0.6% increase in assault hospitalizations (95% CI: 1.003, 1.008). In interaction models, eviction filing rates strengthened the positive associations between outlet density and hospitalizations for both assault and AUD.

Reducing housing evictions may mitigate the impact of alcohol outlet density on AUD and assault. Future research, policy, and practice should explore opportunities for jointly addressing the alcohol environment and neighborhood housing conditions.