Sociodemographic Variation Research Articles

Surgical and transcatheter aortic valve interventions for aortic stenosis in England: sociodemographic variations in treatment trends and outcome over 20 years

BackgroundHealth inequalities in cardiovascular care have been identified in the UK. The sociodemographic characteristics of patients undergoing intervention for aortic stenosis (AS) in England, and the impact of COVID-19, is...

Immigrant Parents' Knowledge and Attitudes: Sociodemographic Variation Related to Restriction of Children's Sugar Intake.

Focusing on immigrant parents with children aged 0-6 months, this study assessed whether awareness of and attitudes towards restricting children's sugar consumption vary according to family sociodemographic background and parents' oral-health-related behaviours. A cross-sectional study was conducted including immigrant parents attending child public health centers for vaccination of their children. The study included parents born in Asia, Africa, South America, Central America and Eastern Europe. Parents from Western Europe and North America were included if they were partners of the above-mentioned participants. Cross-tabulation and multiple variable logistic regression were used to assess associations of parental knowledge and attitudes with their child's sugar intake and sociodemographic characteristics. Overall, response rate was 72.6%. A total of 345 parents completed personal, structured interviews during their visit to the health centers. Attitudes and knowledge, but not indulgence, related to children's sugar restriction were sociodemographically unequally distributed among immigrant parents. Employed mothers, mothers with immigrant background from North America or Western Europe as well as parents with less frequent own sugar intake were more likely to confirm positive attitudes towards restricting children's sugar snacking. The corresponding odds ratios were OR=1.8 (95% CI 1.1-3.1) and OR=6.6 (95% CI 2.3-18.9). Employed mothers and parents having received dental care information were more likely than their counterparts to possess good oral-health-related knowledge. Parents from sociodemographically disadvantaged backgrounds were less inclined to express positive attitudes and demonstrate sufficient knowledge regarding the limitation of their children's sugar snacking. Culturally adapted oral health intervention programs should be implemented for immigrants, with special reference to children's dietary habits.

Association of Demographic Disparities in Maternal Oral Hygiene Status, Caries Experience, and Oral Health Behavior Toward Children in Chengalpattu District, India: A Cross-Sectional Study.

Mothers are the primary caregivers throughout early childhood, playing a vital role in developingtheir child's oral health behavior, as oral conditions in primary teeth can have a considerable negative impact on the child's growth. This study aims to assess the association between maternal oral hygiene status, caries experience, and oral health behavior (OHB) toward their children. A cross-sectional study was conducted among 226 mothers of children aged nine months to three years visiting the primary health centers (PHCs) in urban (n = 113) and rural (n = 113) areas of Chengalpattu district, India. A 24-item questionnaire assessed and compared their OHBtowardchild oral health. Maternal oral hygiene status and caries experience were also assessed.Mann-Whitney-U test was used to compare the OHB scores between mothers from rural and urban areas, and Spearman's rank correlation(rho) was used to find the relationship between OHBwith oral hygiene and the caries experienceof the participants. The results showed significant differences in OHB scores between mothers from rural (mean rank: 86.78) and urban (mean rank: 140.22) backgrounds (p <0.001). Urban respondents had significantly higher knowledge (mean rank: 161.09 vs 65.91 for rural) and better oral health practices (mean rank: 132.00 vs95.00 for rural) compared to their rural counterparts.However, rural respondents significantly showed more positive attitudes than urban respondents (mean rank: 124.80 vs. 102.20 for urban). A strong negative correlation (Spearman's rho of -0.83) was observed between knowledge, attitude, and practice (KAP) scores and Oral Hygiene Index-Simplified (OHI-S)in urbanparticipants, and a moderately negative correlation(-0.683) was observed inrural participants. Maternal oral hygiene has a significant influence on the OHB towardtheir children. This study highlights the critical influence of maternal oral health and demographic factors onthe OHB oftheir children, underscoring the need for targeted public health interventions to address these disparities arising out of rural-urban differences and improve theoral health outcomes for both mothers and children. Mothers can thus explicitly play an indispensable role in fostering positive attitudes and healthy habits towarddental health care in children, regardless of the sociodemographic variations.

A Retrospective Cross-Sectional Study of Clinical Profile of HIV Patients at a Tertiary Care Hospital in Western Part of Maharashtra.

Background and aim In India, socioeconomic factors, healthcare access, and cultural views influence HIV epidemiology. With over two million cases, high-risk groups include drivers, sex workers, and intravenous drug users. Early symptoms often go unnoticed, and advanced stages lead to opportunistic infections. Despite antiretroviral therapy (ART) advancements, access remains a challenge. Effective management per National AIDS Control Organization (NACO) guidelines is essential. This study aimed to understandthe clinical profile of people living with HIV (PLWH) with sociodemographic variation at tertiary care centers in the western part of Maharashtra. Methods and methodology A retrospective descriptive cross-sectional study was conducted on PLWHfrom November 2022 to May 2024. The PLWH patients of all age groups and all categories were included in the study. The sociodemographic data were collected, and clinical staging was done according to the World Health Organization (WHO) classification of HIV/AIDS. Data were expressed as mean±standard deviation and percentage proportion. Results Out of 150 PLWH, 77 (51.33%) were maleand 73 (48.67%) were female patients. The majority of patients, 102 out of 150, were in the age group of 30-50 years. The most common mode of HIV transmission was heterosexual(143 patients, 95.33%). At the time of presentation, 102 patients (68%) were symptomatic, while 48 patients (32%) were asymptomatic. A total of 77 patients (51.33%) were included in WHO clinical stage 2 of HIV disease. In terms of cluster of differentiation 4 (CD 4) count, 62 patients (41.33%) had counts between 201 and 500, 54 patients (36%) had counts greater than 500, and 34 patients (22.67%) had counts below 200. Most patients, 94 (62.67%), had a BMI of less than 18.5. Pulmonary tuberculosis was found to be the most commonly associated opportunistic infection (OI), constituting 57 (38%) cases, followed by acute gastroenteritis 35 (23.33%). Conclusion The demographic and clinical profiles of the study participants highlight the importance of early case detection and the timely initiation of highly active antiretroviral therapy.

Sociodemographic Variations in Organic Food Consumption and Food Choice Motives among Malaysian Adults: A Study between Organic and Non-Organic Food Consumers

Sociodemographic Variations in Organic Food Consumption and Food Choice Motives among Malaysian Adults: A Study between Organic and Non-Organic Food Consumers

Student intersectional sociodemographic and school variation in GCSE final grades in England following Covid-19 examination cancellations

ABSTRACT In 2020, Covid-19 forced the cancellation of all student end-of-school examinations in England. Schools were asked to provide centre assessment grades (CAGs), offering their best estimates for what students would have achieved had they sat their examinations. Although initially replaced in favour of grades calculated via an algorithm, students were eventually awarded their CAGs following widespread public outcry over the calculated grades. Whether CAGs were unfairly awarded across different student groups and schools in 2020 compared to previous years is a key question. However, existing analyses of bias in CAGs are limited by a lack of attention to potential interactions between student characteristics and thus to hidden differential grade inflation across intersectional groups. We addressed this by examining student GCSE performance in 2018, 2019 and 2020 via a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) analysis of intersectional sociodemographic variation which we cross-classified with schools given their role in generating CAGs. Overall, a picture of stability emerged where, despite substantial overall grade inflation in 2020, the use of CAGs did not appear to have generated new or divergent intersectional relationships in comparison to previous years, suggesting CAGs showed a similar susceptibility to bias as normal examinations.

Predictors and Barriers to Breastfeeding Practices Among Jordanian Mothers: A Cross-Sectional Study

Breastfeeding, endorsed by religious, cultural, and scientific evidence, experiences divergent rates in Jordan due to substantial sociodemographic and cultural variations. Our aim is to explore the predictors and barriers that affect BF practices among mothers in Southern Jordan, in order to insight the healthcare providers to identify these barriers in order to increase awareness for the initiation and continuation of breastfeeding. A cross-sectional study was conducted among 380 mothers with infant 2 weeks to 6 months old. Data were analyzed using descriptive statistics and multinomial logistic regression. Findings revealed exclusive breastfeeding at 24%, mixed feeding at 57.63%, and artificial feeding at 18.42%. The study illuminated pronounced barriers in socio-environmental factors (1.65 ± 0.32), infant factors (1.63 ± 0.37), and maternal (1.59 ± 0.27). Predictors encompassed maternal age, education, employment, province, income, family member, delivery mode, and prior breastfeeding experience. In South Jordan, mixed feeding was the commonest way. Mothers’ work and lack of nursery at the workplace was the most noticeable factor. This study equips healthcare providers to recognize barriers hampering breastfeeding among Jordanian mothers, enabling informed strategies to enhance awareness and sustain breastfeeding initiation and continuation.

Temporal Trends in the Epidemiology of Lower Back Pain in the United States.

This was an observational study. This study aims to explore sociodemographic and regional geographic variations in lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000 to 2019). LBP is a major contributor to lost wages and disability in the United States. As LBP is associated with increasing age and sedentary lifestyle, the incidence of LBP is expected to rise. Due to LBP's multifactorial causes, US epidemiological trends lack sufficient data. Descriptive epidemiological data including disability-adjusted life years (DALYs), incidence, and prevalence per 100,000 population from 2000 to 2019 were collected from the Global Burden of Disease database. State-level data regarding poverty, insurance and employment status were obtained from the US Government Census Bureau and US Department of Labor. Statistical significance was indicated by P <0.05. From 2000 to 2019, the US demonstrated reductions in LBP incidence, prevalence, and DALYs. Regional analysis demonstrated the Midwest to have the greatest mean incidence, prevalence, and DALYs; with Midwestern females significantly more affected than females in other regions. Those aged 25 to 49 in the Midwest were impacted significantly more across all measures compared with age-matched populations in other regions. Nationally, there were no significant associations between unemployment and LBP. Poverty was inversely correlated with LBP incidence. Uninsured status was positively correlated with prevalence and DALYs. Although there has been progress in reducing the impact of LBP in the United States, the Midwest region has greater rates for all measures compared with other US regions. Further, females and those aged 25 to 49 in the Midwest were more likely to be affected by LBP compared with counterparts in other regions. Future studies should identify specific factors contributing to elevated LBP rates in the Midwest in order to guide targeted interventions to reduce the incidence and burden of LBP there.

Socio-demographic variations in prostate cancer diagnosis recording: Primary care compared to the Cancer Registry in England

IntroductionIn the UK, primary care data are often used for cancer-related research, but the accuracy of cancer information is uncertain. ObjectiveWe investigated socio-demographic variation based on the recording date of prostate cancer diagnosis between primary care and the National Cancer Registry (CR). ApproachWe utilised a data extract of 1,600,000 patients over 65 years from Clinical Practice Research Datalink (CPRD). We extracted prostate cancer diagnoses using Read and SNOMED-CT codes from primary care, and ICD-10 from CR. Initial code entry determined diagnosis dates. We categorised recording timing differences as earlier, same-day or later in primary care than CR and used the chi-squared test and logistic regression (adjusted for recording year) to compare these discrepancies across age, deprivation, and ethnicity. ResultsWe included 26,875 men with prostate cancer diagnoses commonly recorded in both sources during 2000-2016 (1,030 excluded with missing ethnicity). Compared to CR, 1,747 (7%) had diagnoses recorded on the same day in primary care, while 20,615 (77%) had later recordings with a median delay of 21 days (IQR: 13-38). Age at diagnosis was associated with recording discrepancies (p&lt;0.001); older men were more likely to have earlier/same-day recordings. Adjusted ORs for age groups were 1.4 (95%CI: 1.3-1.5) for 60-69, 1.3 (1.2-1.5) for 70-79, and 0.9 (0.8-1.0) for ≥80 compared to &lt;60. No associations were found between deprivation (p=0.096) or ethnicity (p=0.067) and recording differences. Conclusion/ ImplicationsThe discrepancy in prostate cancer information between primary care and CR underscores potential biases in studies relying solely on one data source.

Associations between rural/urban status, duration of untreated psychosis and mode of onset of psychosis: a mental health electronic clinical records analysis in the East of England, UK.

The influence of rurality on the duration of untreated psychosis (DUP) in first-episode psychosis (FEP) is poorly understood. We investigated factors associated with FEP in rural/urban settings and whether there are rural/urban differences in DUP and the mode (speed) of onset of psychosis. We used the Cambridgeshire and Peterborough NHS Foundation Trust Research Database (CPFTRD) to identify all persons presenting to an early intervention for psychosis service with FEP between 2013 and 2015. We performed descriptive statistics and multivariable linear and multinomial regression to assess the relationships between the study outcomes and the independent variables. One hundred and fifty-five FEP patients were identified, with a mean age of 23.4 (SD, 5.3) years. The median DUP was 129.0 (IQR: 27.5-524.0) days. In rural areas, FEP patients were more likely to be employed and live with family than those in urban areas. A longer DUP was observed among patients with an insidious onset of psychosis compared with an acute onset (619.5 (IQR: 333.5-945.0)) vs. (17.0 (IQR: 8.0-30.5)) days respectively, p < 0.0001. We found evidence that the mode of onset of psychosis differed by employment status and living circumstances. There was insufficient evidence of rural/urban differences in DUP and mode of onset of psychosis. Our results suggest that the mode of onset of psychosis is an important indicator of treatment delay and could provide vital information for service planning and delivery. Sociodemographic variations in FEP exist in rural populations, and our findings are similar to those observed in urban settings.

Prevalence and Socio-demographic Variations in Traditional Medicine Use: A Study from East Nile Locality, Sudan

Traditional medicine (TM) remains a cornerstone of healthcare in Sudan, across urban and rural settings. We explored TM use and its association with socio-demographic characteristics (age, sex, education, economic status, and residence) in East Nile locality (ShargAlneil), Khartoum State. A survey encompassing 609 households (44.7% rural, 55.3% urban) revealed a high prevalence of TM use: over 80% reported using at least one form. Notably, significant socio-demographic variations emerged. Individuals with higher education leaned towards herbalists (p&lt;0.05), while those with lower education favored religious healers (p&lt;0.05). Similarly, older adults preferred religious healers (p&lt;0.05), while males tended to choose herbalists (p&lt;0.05). The most common ailments preferred to be treated by TM practitioners were spiritual and psychological issues, bone injuries, stomachaches, and headaches. Conversely, conditions like malaria, diabetes, hypertension, and heart disease were primarily preferred to be managed by modern medicine. This study highlights the widespread use of TM across diverse demographics, with preferences for specific types of practitioners. It also underscores a selective trust in modern medicine for certain diseases. Integrating socio-demographic and cultural perspectives into healthcare delivery can enhance understanding of community needs and guide the development of appropriate interventions. Further research is warranted to delve deeper into the reasons behind these variations in treatment preferences.

Rule-based natural language processing to examine variation in worsening heart failure hospitalizations by age, sex, race and ethnicity, and left ventricular ejection fraction

BackgroundPrior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates. MethodsAdult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014-2018 were followed through 2019 to identify hospitalized WHFE. The main outcome was hospitalizations with a principal or secondary HF discharge diagnosis meeting rule-based Natural Language Processing (NLP) criteria for WHFE. In comparison, we examined hospitalizations with a principal discharge diagnosis of HF. Age-, sex-, and race and ethnicity-adjusted rates per 100 person-years (PY) were calculated among age, sex, race and ethnicity (non-Hispanic (NH) Asian/Pacific Islander [API], Hispanic, NH Black, NH White) and LVEF subgroups. ResultsAmong 44,863 adults with HF, 10,560 (23.5%) had an NLP-defined, hospitalized WHFE. Adjusted rates (per 100 PY) of WHFE using NLP were higher compared to rates based only on HF principal discharge diagnosis codes (12.7 and 9.3, respectively), and this followed similar patterns among subgroups, with the highest rates among adults ≥75 years (16.3 and 11.2), men (13.2 and 9.7), and NH Black (16.9 and 14.3) and Hispanic adults (15.3 and 11.4), and adults with reduced LVEF (16.2 and 14.0). Using NLP disproportionately increased the perceived burden of WHFE among API and adults with mid-range and preserved LVEF. ConclusionRule-based NLP improved the capture of hospitalized WHFE above principal discharge diagnosis codes alone. Applying standardized consensus definitions to EHR data may improve understanding of the burden of WHFE and promote optimal care overall and in specific sociodemographic groups.

Maryland opioid overdose deaths from 2018 to 2022: occupational patterns and their sociodemographic variations

IntroductionWe aimed to describe the occupational pattern of opioid overdose deaths in Maryland between 2018 and 2022 and determine the occupations at higher risk of opioid overdose death.MethodsThe sample included...

Sociodemographic Variations on Public Service Motivation among Health Professionals in Portugal: Insights Post-COVID-19 Pandemic

Sociodemographic Variations on Public Service Motivation among Health Professionals in Portugal: Insights Post-COVID-19 Pandemic

Intention to have blood-based multi-cancer early detection (MCED) screening: a cross-sectional population-based survey in England

BackgroundTrials assessing the clinical utility of blood-based multi-cancer early detection (MCED) tests are underway. Understanding public attitudes towards MCED screening is essential if these tests are to be used. We aimed to quantify MCED screening intention and potential barriers and facilitators to uptake.MethodsAdults aged 50–77 (n = 958) completed an online survey. The primary outcome was intention to have MCED screening if offered. Psychological variables including barriers and facilitators were assessed. We used logistic regressions to explore associations between socio-demographics and psychological factors and intention.Results93.8% of participants said they would ‘definitely’ or ‘probably’ have MCED screening if offered. Intention was significantly associated with previous screening participation and general cancer attitudes but not with socio-demographic factors. Participants were more likely to be intenders if they had higher health motivation, and perceived greater benefits of blood tests. Participants were less likely to be intenders if they perceived greater disadvantages of blood tests, more practical barriers, were more worried about the outcome and more concerned about a positive result.Conclusions and implicationsMCED screening intention was high. The lack of socio-demographic variation suggests equitable interest in this type of screening; however, future research should consider how intention translates to uptake.

How old do I look? Aging appearance and experiences of aging among U.S. adults ages 50-80.

Appearance is an indicator of age and life stage, which are linked to socially salient stereotypes and prejudices. Older adults' appearance-related perceptions and behaviors may affect their experiences of aging within broader society, which may in turn influence health. This study examined associations between two measures related to aging appearance-assessment of one's aging appearance relative to same-age peers and investing time or effort to look younger-positive and negative experiences of aging, and health using multivariable regression. Cross-sectional data were from a nationally representative sample of 2006 U.S. adults ages 50-80 (Mage = 63, 52% women, 71% White) who completed Wave 6 of the National Poll on Healthy Aging in 2019. The majority (59%) reported appearing relatively younger than peers, while fewer reported appearing the same age (35%) or older (6%). About a third (35%) reported investing in looking younger. Appearing relatively younger was associated with more positive (p < .001) and less negative experiences of aging (p = .019). Appearing relatively older showed the opposite relationships (p values < .001). Investing in looking younger was associated with more positive and more negative experiences of aging (p values < .001). Few sociodemographic variations were detected. More positive and less negative experiences of aging were associated with better physical and mental health (p values < .001). While aging appearance is often the basis for jokes, it may affect the quality of older adults' experiences of aging and associated health outcomes. Nuanced findings caution against framing youthful biases in aging appearance and investments in looking younger as solely negative (or positive). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotional and cognitive influences on alcohol consumption in middle-aged and elderly Tanzanians: a population-based study

Alcohol consumption in Tanzania exceeds the global average. While sociodemographic difference in alcohol consumption in Tanzania have been studied, the relationship between psycho-cognitive phenomena and alcohol consumption has garnered little attention. Our study examines how depressive symptoms and cognitive performance affect alcohol consumption, considering sociodemographic variations. We interviewed 2299 Tanzanian adults, with an average age of 53 years, to assess their alcohol consumption, depressive symptoms, cognitive performance, and sociodemographic characteristics using a zero-inflated negative binomial regression model. The logistic portion of our model revealed that the likelihood alcohol consumption increased by 8.4% (95% confidence interval [CI] 3.6%, 13.1%, p < 0.001) as depressive symptom severity increased. Conversely, the count portion of the model indicated that with each one-unit increase in the severity of depressive symptoms, the estimated number of drinks decreased by 2.3% (95% CI [0.4%, 4.0%], p = .016). Additionally, the number of drinks consumed decreased by 4.7% (95% CI [1.2%, 8.1%], p = .010) for each increased cognitive score. Men exhibited higher alcohol consumption than women, and Christians tended to consume more than Muslims. These findings suggest that middle-aged and elderly adults in Tanzania tend to consume alcohol when they feel depressed but moderate their drinking habits by leveraging their cognitive abilities.

The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey.

NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients' primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). We categorized practices as "low-use" or "high-use" according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models-shorter "free text" input with an embedded single workflow OC system (FT practices) and longer "mixed text" input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience-overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8% (odds ratio [OR] 0.802, 95% CI 0.782-0.823) less likely to report a good overall experience; 24.5% (OR 0.755, 95% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9% (OR 0.811, 95% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8% (OR 1.278, 95% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups-patients from urban and deprived areas, younger patients, and non-White patients. An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients.

Factors associated with homeless experiences amid the COVID-19 pandemic in the Nipissing District, Ontario, Canada.

Canadian homelessness is an ongoing issue, especially in the Nipissing District, Ontario, where agencies work to support those in need. However, these efforts were challenged with the sudden onset of the COVID-19 pandemic. Drawing on the Cycle of Homelessness model, this study examines sociodemographic factors associated with homeless experiences during the pandemic. Using data from the 2021 (n = 207) Nipissing District homeless enumeration survey and employing bivariate and multivariate binary logistic analyses, this study examined sociodemographic factors associated with reasons of homelessness, barriers to housing loss and experiences of chronic and episodic homelessness during the pandemic. The results showed a significant sociodemographic variation in the experiences of the homeless population during the COVID-19 pandemic. Those over the age of 35 versus their younger counterparts were more likely (43.7%) found in emergency shelters. Multivariate findings indicated that females experienced housing/financial loss and interpersonal/family issues, directly causing homelessness, 2.2 and 2.5 times more than males, respectively. Welfare recipients were more likely to experience health-related reasons for housing loss (Odds Ratio (OR): 2.8), chronic homelessness (OR: 3.3), addiction (OR: 2.9), and mental health-related barriers to housing (OR: 4.1). Those aged 25-34, 25-44, and 45+ were 7.9, 4.9, and 5.1 times more likely to face chronic homelessness. Conclusions: Welfare recipients are more at-risk of health-related housing loss, addiction, and mental health barriers to housing, and chronic homelessness. This could be attributed to poor public planning and policies that put people in marginal economic and housing circumstances, especially during the pandemic. Therefore, policy reform is required to address the main barriers in eliminating homelessness.

Slow burn: Weak energy transition in a growing economy

Despite impressive recent gains in income (now classified by the World Bank as a “high income country”), and access to alternative heating systems, Chileans continue to have amongst the highest levels of per-capita wood consumption in the world, with serious attendant health and environmental implications. In this paper, we estimate the income elasticity of the use of firewood as a primary residential heating system in Chilean households. Our estimate accounts for the country’s climatic, geographic, and socio-demographic variation; controls for multiple levels of fixed-effects and covariates; and accounts for selection—as some households choose no heating systems whatsoever. We find that an increase of income of 10% decreases the probability of firewood use by about one-tenth of a percentage point, a statistically significant but economically trivial effect. This result, consistent across various robustness checks, provides evidence for an extremely weak income-based energy transition in Chile. It implies that passive environmental policy, expecting a reduction of firewood use exclusively from income growth will fail. If the Chilean government’s aim is to lower the detrimental health and environmental outcomes associated with firewood use, they will have to adopt more aggressive approaches.