Economics And Human Biology[JOURNAL]
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200 papers
The impact of super apps on the nutrition transition in low- and middle-income countries: Evidence from Indonesia.
Elmira ES, Suryahadi A
Econ Hum Biol · 2025 Dec · PMID 40896983 · Publisher ↗
Many low- and middle-income countries (LMICs) are experiencing a nutrition transition from traditional diets to high-energy, processed foods, increasing non-communicable disease risks. Digitalization of food systems play...
Many low- and middle-income countries (LMICs) are experiencing a nutrition transition from traditional diets to high-energy, processed foods, increasing non-communicable disease risks. Digitalization of food systems plays a significant role in shaping this transition. This paper investigates the impact of super app expansions (including food delivery, ridesharing, and other daily life assistance) on nutritional outcomes. We exploit the staggered rollout of Gojek and Grab between 2015 and 2018 in Indonesia to estimate their effects on nutritional and dietary outcomes, combining super app expansion data with Indonesia's Basic Health Survey (Riskesdas) and the National Socioeconomic Survey (Susenas). We incorporate baseline covariates using a doubly robust difference-in-differences approach to tackle endogeneity issues. The results show that super apps increase BMI, which adversely affects the incidence of overweight and obesity. The effect is more pronounced in cities and districts with online food delivery features. These apps disproportionally increase BMI among individuals who are already overweight/obese, younger, and more affluent (i.e., higher education, higher income, in employment), indicating higher usage among these groups. This is due to increased consumption of unhealthy food (i.e., salty and prepared foods). On the other hand, super apps have the potential to reduce underweight and improve dietary diversity. These findings highlight the role of super apps in the nutrition transition in LMICs.
Expensive famine: Early hunger experience and diabetes treatment burden.
Zhu G, Wang L, Xuejun W
Econ Hum Biol · 2025 Sep · PMID 40784264 · Publisher ↗
The negative effects of experiencing famine in childhood are not limited to increased morbidity. This study collected hospitalization data for diabetic patients in all hospitals in Gansu Province over a three-year period...
The negative effects of experiencing famine in childhood are not limited to increased morbidity. This study collected hospitalization data for diabetic patients in all hospitals in Gansu Province over a three-year period (2018-2020) and exploited the exogenous shock of the Great Famine event in China (1959-1961). We used a birth cohort DID method to assess the causal relationship between famine survivors and diabetes treatment costs. In a sample of patients with type 2 diabetes, treatment costs were higher for famine survivors than for other patients, especially those born between 1952 and 1957. However, there was no significant difference between patients born between 1959 and 1961, which may challenge the "fetal origin" hypothesis. The costs of hunger are all-encompassing, including worse health before hospitalization, a greater likelihood of surgery, and higher recovery costs after discharge. Findings also hint at differences in the burden of diabetes between insulin-insufficient and sugar-excessive. There are significant differences within survivors of different social statuses, and the low bargaining power of rural and female groups was amplified during the famine. Ethnic differences reflect more complex mechanisms of food acquisition. Even though 63-67 years old is the window period when the burden of diabetic patients who experienced famine in their early life increases significantly, these high medical burdens are effectively compensated under the medical insurance system.
The impact of new energy demonstration city policy on the mental health of middle-aged and older adults.
Wan S, Zhou Y, Zhou L … +2 more , Chen S, Qi F
Econ Hum Biol · 2025 Sep · PMID 40773925 · Publisher ↗
China's initiative to develop new energy demonstration cities aims to drive economic restructuring and green development by targeting urban energy use, air quality, and industrial impacts, yet its effects on middle-aged...
China's initiative to develop new energy demonstration cities aims to drive economic restructuring and green development by targeting urban energy use, air quality, and industrial impacts, yet its effects on middle-aged and older adults' mental health remain underexplored. This study investigates these effects using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, focusing on 8988 participants and employing a difference-in-differences model to evaluate self-reported health and depressive symptoms. First, the research finds that new energy city projects significantly improve mental health in middle-aged and older adults, with participants exhibiting fewer depressive symptoms, the results validated through multiple robustness checks. Second, these mental health benefits are mediated by improved energy efficiency, better air quality, increased employment opportunities, energy transitions, enhanced social activities, and higher life satisfaction. Third, the magnitude of these benefits varies across demographics, with greater improvements observed among middle-aged and older adults with higher cognitive abilities, urban residents, and those in eastern China.
Public Policies and Femicides during the COVID-19 Pandemic: Evidence from São Paulo, Brazil.
Diaz MDM, Pereda P, Rocha F … +5 more , Oliveira PAC, Árabe IB, Kreif N, Lordemus S, Moreno-Serra R
Econ Hum Biol · 2025 Sep · PMID 40768866 · Publisher ↗
With the outbreak of the COVID-19 pandemic in early 2020, concerns arose that stay-at-home policies could exacerbate Violence Against Women (VAW). Evidence shows an increase in calls to domestic violence helplines in sev...
With the outbreak of the COVID-19 pandemic in early 2020, concerns arose that stay-at-home policies could exacerbate Violence Against Women (VAW). Evidence shows an increase in calls to domestic violence helplines in several countries. However, limited economic studies have investigated the pandemic's effects on femicides, the most extreme form of VAW. This paper examines the effects of social isolation measures and emergency aid policies implemented during the COVID-19 outbreak on femicides in São Paulo, Brazil. Using daily femicide data from 2016 to 2020, a social isolation index, and monthly employment and emergency cash transfer data, we estimate fixed-effects models. Our findings reveal that the probability of femicide more than doubled (0.32 p.p.) during periods of pronounced isolation (March-April 2020). The impact was more significant in poorer municipalities, where male job losses drove this increase. However, the provision of emergency aid in poorer areas, which covered 29.8% of the population in these areas, mitigated this harmful effect, reducing it by more than twice the magnitude of the employment shock. These results underline the interplay between economic conditions, social policies, and gender-based violence during crises.
Economic freedom and gender health gap in the E.U.
Migheli M
Econ Hum Biol · 2025 Sep · PMID 40753724 · Publisher ↗
This paper investigates the relationship between economic freedom and the gender health gap across European Union member states. Drawing on data from the European Institute for Gender Equality and the Fraser Institute's...
This paper investigates the relationship between economic freedom and the gender health gap across European Union member states. Drawing on data from the European Institute for Gender Equality and the Fraser Institute's Economic Freedom Index, the analysis explores how liberal economic policies influence health disparities between men and women. While liberal reforms are often promoted for enhancing overall economic efficiency, their impact on gendered health outcomes is nuanced. The findings suggest that certain aspects of economic freedom, such as regulatory and trade policies, can either reduce or exacerbate gender health inequalities, depending on the domain and specific indicator considered. Notably, labour market deregulation often disadvantages women, while increased judicial independence and reduced trade barriers show mixed effects. The paper employs panel data econometrics with instrumental variables to address potential endogeneity, revealing complex, often non-linear relationships between economic policy and health inequality. These insights imply that liberal reforms are not gender-neutral and may require compensatory social policies to ensure equitable health outcomes. The study contributes to an underexplored area by highlighting the importance of considering gender equity in the design and evaluation of economic policy, particularly in health-related domains.
Heterogeneous impacts of climate change on morbidity.
Hajdu T
Econ Hum Biol · 2025 Sep · PMID 40749329 · Publisher ↗
This paper examines the effect of temperature on emergency department (ED) visits using administrative data covering 50 % of the Hungarian population and 3.52 million ED visits from 2009 to 2017. The results show that ED...
This paper examines the effect of temperature on emergency department (ED) visits using administrative data covering 50 % of the Hungarian population and 3.52 million ED visits from 2009 to 2017. The results show that ED visit rates increase when average temperatures exceed 10°C, primarily driven by mild cases that do not result in hospitalization. Higher humidity amplifies the heat effect, which is also stronger following consecutive hot days. The findings further indicate that the impacts of climate change - both present and future - are substantial. Between 2009 and 2017, 0.66 % of the ED visits were attributed to temperature changes relative to the period 1950-1989. Furthermore, by the 2050s, compared to the first 15 years of the 21st century, the annual ED visit rate is projected to rise by 1.24 %-1.70 %, depending on the climate scenario. A heterogeneity analysis reveals that the effects of high temperatures and the future impacts of climate change are disproportionately greater in lower-income districts, areas with lower general practitioner density, and among younger adults.
When the thermometer rises, the scales tip: Extreme temperature exposure and obesity.
Ampofo A, Churchill REA, Awaworyi Churchill S
Econ Hum Biol · 2025 Sep · PMID 40749328 · Publisher ↗
Obesity is a global public health issue, with over 1.9 billion adults reported to be either overweight or obese. Despite the high financial and health costs associated with obesity, the global prevalence of obesity acros...
Obesity is a global public health issue, with over 1.9 billion adults reported to be either overweight or obese. Despite the high financial and health costs associated with obesity, the global prevalence of obesity across all age groups has been on the rise. Using the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we provide evidence of the causal relationship between extreme temperature exposure and obesity. We show that there is a positive association between high temperatures (above 30°C) and obesity. Specifically, an additional day of exposure to temperatures above 30°C in a year is associated with a 0.02 percent increase in BMI and a 0.2 percent increase in the probability of being obese. We find these effects to be pronounced for older cohorts, and robust to alternative specifications and falsification of our extreme temperature exposure measure. We provide evidence that the underlying mechanisms for our baseline relationship are reduced physical activities and low internal locus of control due to extreme temperature exposure.
Impacts of a minimum pricing policy on high fat, sugar and sodium (HFSS) foods: Environmental, dietary and welfare analysis.
Dogbe W, Huang K, Revoredo-Giha C
Econ Hum Biol · 2025 Sep · PMID 40737721 · Publisher ↗
Foods high in fat, sugar and salt (HFSS) are detrimental to people's health, social well-being and the environment. Minimum unit pricing has shown potential to reduce cigarette and alcohol consumption, but it is unpopula...
Foods high in fat, sugar and salt (HFSS) are detrimental to people's health, social well-being and the environment. Minimum unit pricing has shown potential to reduce cigarette and alcohol consumption, but it is unpopular in the food and drinks sectors. This research aims to simulate the shadow price or minimum price for HFSS that could potentially reduce demand by 10 %, and estimate the impacts on nutrition, climate and economic welfare in Scotland. The Linear Approximate Exact Affine Stone Index (LA/EASI) demand model was applied to household consumption data from Kantar Worldpanel (KWP) to derive elasticities that were used to simulate the minimum prices for the HFSS categories considered. Greenhouse gas emission estimates were derived from the SHARP Indicators Database (SHARP-ID) to estimate CO-eq changes, and the log of living cost index was used to estimate the economic welfare effect of the policy. The expected minimum increment in prices with respect to the baseline price was approximately 28 % for edible ices and ice cream, 9 % for sugary drinks and 10-17 % for total puddings and desserts; biscuits and savouries; and confectionery, cakes, pastries and sugar morning goods. This had implications for non-targeted foods. For instance, the purchase of fruit and vegetables decreased by 0.47 % and 0.82 % respectively, whilst sugar and preserve purchases increased by 1.30 %, marginally discounting the benefits of the policy. On the positive side, purchases of meat, fish and alcohol decreased, and dairy product purchases increased. For the average per capita dietary carbon footprint, the policy reduced net average total CO-eq emissions by 0.7 %. However, consumers would require a 12.3 % increase in expenditure to consume the same basket of food as before the price change. In summary, although the policy is expected to improve climate health, there will be negative unintended effects on non-targeted foods, as well as economic welfare loss if consumers decide not to change their consumption habits. It is recommended that policymakers consider the net total effect of the minimum pricing before introducing it in the food and drinks sector.
Individualism and support for COVID-19 government interventions: The moderating role of perceived economic risk.
Jiang Y, Yin G, Shao Q
Econ Hum Biol · 2025 Sep · PMID 40712311 · Publisher ↗
Individualistic orientations in cultural worldviews significantly influence public attitudes toward government policies. We examine the impact and mechanisms of individualism on support for government interventions, focu...
Individualistic orientations in cultural worldviews significantly influence public attitudes toward government policies. We examine the impact and mechanisms of individualism on support for government interventions, focusing on the economic effects of COVID-19 containment measures. Utilizing data from the 10th and the latest 11th rounds of the European Social Survey (ESS), we find that individualism exerts a significant negative effect on public support for COVID-19 government interventions. Specifically, for each additional point increase in individualism corresponds to a 1.6 % decrease in the probability of viewing border closures as extremely important and a 1.4 % decrease for domestic movement restrictions. Our mechanism analysis reveals that individualism negatively affects intervention support by diminishing trust in government. Furthermore, higher perceived economic risk amplifies the negative impact of individualism on intervention support. Heterogeneity tests demonstrate that the negative influence of individualism is more pronounced among older individuals, those with lower income and education levels, employees in government and public sectors, and in non-post-socialist countries. We suggest that strategies to promote public policy support should be tailored to cultural and social contexts.
Harder being left behind: Health status of Indian women from migrant households.
Tabassum S, Lalji C
Econ Hum Biol · 2025 Sep · PMID 40712310 · Publisher ↗
Using the two waves (2004-05 and 2011-12) of the India Human Development Survey (IHDS), a nationally representative dataset, we examine the health status of women (using objective health measures such as body mass index...
Using the two waves (2004-05 and 2011-12) of the India Human Development Survey (IHDS), a nationally representative dataset, we examine the health status of women (using objective health measures such as body mass index (BMI) and incidence of underweight) in migrant households relative to women in non-migrant households. The findings of the paper reveal a concerning pattern of poor health status among women in migrant households characterized by a lower BMI and a higher incidence of underweight vis-à-vis their non-migrant counterparts. The results emphasize the pivotal roles of women empowerment and social networks in mitigating the adverse health consequences of migration.
More Than a Ban on Smoking? Behavioural Spillovers of Smoking Bans in the Workplace.
Costa-Font J, Salmasi L, Zaccagni S
Econ Hum Biol · 2025 Sep · PMID 40695165 · Publisher ↗
We study the potential behavioural spillover effects of a workplace smoking ban (WSB) on a variety of health-related behaviours as well as on people who are not directly impacted by the bans. Drawing on quasi-experimenta...
We study the potential behavioural spillover effects of a workplace smoking ban (WSB) on a variety of health-related behaviours as well as on people who are not directly impacted by the bans. Drawing on quasi-experimental evidence comparing employed and unemployed individuals in Russia, we document that individuals who give up smoking are less likely to drink or cut back on alcohol consumption. Furthermore, we show that as expected the WSB exerts an impact on the health behaviours of those who are not directly exposed to the reform, such as never smokers. Finally, the effects of the WSB are driven by changes among men, 60 percent of whom were smoking before the ban.
Drivers of COVID-19 in U.S. counties: A wave-level analysis.
Baum CF, García-Suaza A, Henry M … +1 more , Otero J
Econ Hum Biol · 2025 Sep · PMID 40674959 · Publisher ↗
Since the initial COVID-19 outbreak, researchers from a variety of scientific disciplines have sought to understand the factors influencing the evolution of cases and fatalities worldwide. This study proposes a two-stage...
Since the initial COVID-19 outbreak, researchers from a variety of scientific disciplines have sought to understand the factors influencing the evolution of cases and fatalities worldwide. This study proposes a two-stage econometric modeling approach that first identifies the speed of transmission followed by an examination of socioeconomic, demographic, health, epidemiological, climate, pollution, and political factors as potential drivers of COVID-19 spread across waves and counties in the United States. Utilizing daily data on confirmed cases and deaths from 3014 counties across 48 contiguous states and the District of Columbia from March 2020 to March 2022, we find that the trajectory of the pandemic and vaccination uptake patterns were influenced by a complex interplay of demographic characteristics, socioeconomic factors, health determinants, and policy interventions that differential affected viral transmissibility, mortality outcomes, and immunization efficacy across the six distinct pandemic waves. This analysis provides insights into pandemic dynamics across distinct waves and geographic regions.
Links between COVID-19 lockdowns and drug overdose deaths, evidence from panel data.
Wang Y
Econ Hum Biol · 2025 Sep · PMID 40644938 · Publisher ↗
This paper studies the impacts of divergent state government responses to the COVID-19 pandemic on drug overdose deaths. Using Difference-in-Differences method, I exploit the cross-state variation in the timing of lockdo...
This paper studies the impacts of divergent state government responses to the COVID-19 pandemic on drug overdose deaths. Using Difference-in-Differences method, I exploit the cross-state variation in the timing of lockdown policies to examine how COVID-19 lockdowns affected drug overdose deaths. To the author's knowledge, this is the first study that comprehensively examines the causal links between COVID-19 lockdowns and drug overdose deaths in the US. By emphasizing the impacts of lockdown "mandates" vs. "recommendations," I find credible evidence supporting that the implementation of lockdown mandates led to more drug overdose deaths. My baseline estimates indicate a 15% to 20% increase in drug overdose deaths. To make my results generalizable, I examine three potential mechanisms, including labor market outcomes, mental health, and isolation. I find that isolation induced by the COVID-19 lockdown mandates likely contributes to the increase in drug overdose deaths, while there is only weak evidence that labor market outcomes and mental health serve as plausible channels.
The intergenerational association of epigenetic modifications between mothers and offspring, from birth to adolescence.
Costi C, Menta G, Fiorito G … +1 more , D'Ambrosio C
Econ Hum Biol · 2025 Sep · PMID 40483985 · Publisher ↗
Epigenetic modifications, such as DNA methylation (DNAm), have an important role in human disease development, with early DNAm patterns potentially influencing health outcomes in later life. In this paper, we examine the...
Epigenetic modifications, such as DNA methylation (DNAm), have an important role in human disease development, with early DNAm patterns potentially influencing health outcomes in later life. In this paper, we examine the intergenerational association of epigenetic mutation load (EML), a biomarker of epigenetic instability, identifying DNAm outliers. Using mother-child dyads from a UK-based cohort study, we examine the intergenerational association of EML at three time points: birth, childhood (mean age 7.5), and adolescence (mean age 17). We find significant associations of maternal EML with offspring EML during childhood and adolescence, while this association is absent at birth. This suggests that shared environment, rather than direct biological transmission, might be playing a larger role in this intergenerational correlation. When looking at the association between own EML, and maternal EML, with early-adulthood outcomes, results suggest that own EML predicts worse cognitive abilities later in life, while maternal EML is not directly associated to offspring's outcomes.
Evaluating the impact of long-term care insurance reform on health-related quality of life and inequality among older adults in China: A quasi-experimental analysis.
Lin L, He M, Zai X
Econ Hum Biol · 2025 Sep · PMID 40472421 · Publisher ↗
Less is known about whether and to what extent Long-Term Care Insurance (LTCI) promotes the Health-Related Quality of Life (HRQoL) of older individuals, a vital health outcome for healthy aging. This study utilizes longi...
Less is known about whether and to what extent Long-Term Care Insurance (LTCI) promotes the Health-Related Quality of Life (HRQoL) of older individuals, a vital health outcome for healthy aging. This study utilizes longitudinal data from CHARLS and employs the widely-used EQ-5D-3L method to measure HRQoL. Using the LTCI pilot-which has been implemented in a staggered manner since 2012-as a quasi-experiment, we apply a difference-in-differences approach and find that LTCI increases the HRQoL of older adults aged 60 and older by 1.5%-2% and those aged 70+ by 3.3%. These results suggest that the public LTCI reform in China enhances the HRQoL for the older individuals but only to a relatively modest degree. This minor improvement in HRQoL is primarily driven by increased utilization of formal care, reduced financial strain due to decreased medical expenses, and increased psychological well-being. However, we also find that the current LTCI reform, which mainly targets urban employees and residents, inadvertently exacerbates the urban-rural disparity in HRQoL of older adults.
In the eye of the storm. Long-term impact of the Covid-19 pandemic on healthcare utilization in Lombardy.
Franzoni F, Lucifora C, Russo AG … +1 more , Vigani D
Econ Hum Biol · 2025 Sep · PMID 40472420 · Publisher ↗
Covid-19 induced an increase in unmet health needs due to mobility restrictions and social distancing policies, fear of contagion and overload of healthcare facilities. Using administrative data for the Metropolitan Area...
Covid-19 induced an increase in unmet health needs due to mobility restrictions and social distancing policies, fear of contagion and overload of healthcare facilities. Using administrative data for the Metropolitan Area of Milan in Lombardy and a rigorous empirical strategy, this paper investigates the impact of Covid-19 on the provision of outpatient care between January 2018 and June 2021. We find a large and persistent drop in outpatient treatments, with heterogeneous variations across age groups and chronic status of patients, as well as diagnostic categories of treatments. Results also reveal a significant role played by policy response to Covid-19 and behavioral changes in health-seeking behaviors in shaping the Covid-induced variation in outpatients. Finally, we estimate a cumulative and persistent loss in outpatient care around 25 percent over the period of interest, with an accumulated delay of 4.5 standard months.
Empowering women, enhancing diets: The impact of women's bargaining power on dietary quality in urban China.
Shang W, Zhou Y, Tian X
Econ Hum Biol · 2025 Sep · PMID 40466594 · Publisher ↗
This paper investigates the influence of women's empowerment on the dietary quality of urban residents in China, considering the country's evolving gender dynamics. Utilizing data from 2022 to 2023 and employing instrume...
This paper investigates the influence of women's empowerment on the dietary quality of urban residents in China, considering the country's evolving gender dynamics. Utilizing data from 2022 to 2023 and employing instrumental variable method to address endogeneity issue, our analysis reveals that urban residents living in families with higher female bargaining power are more likely to meet the dietary guideline set by the Chinese Dietary Pagoda. Specifically, these residents exhibit reduced consumption of meat which are current overconsumed, while increasing their intake of dairy products which are current under-consumed. Furthermore, in households with children, enhanced bargaining power of women is associated with a broader variety of food consumption. The effects on dietary quality are particularly notable in low-income households, and there is a significant increase in egg consumption in smaller cities. These changes are likely driven by increased food expenditures and a reduced frequency of dining out. The findings underscore the importance of women's empowerment as a key factor in improving urban dietary habits in China, with substantial implications for public health and nutrition.
The effects of adolescent depression and attention-deficit/hyperactivity disorder on educational attainment in adulthood.
Chen J, Weng A
Econ Hum Biol · 2025 Sep · PMID 40460547 · Publisher ↗
Early-onset mental disorders, particularly depression and attention-deficit/hyperactivity disorder (ADHD), are a growing concern among U.S. adolescents. Previous research offers inconclusive findings on how these conditi...
Early-onset mental disorders, particularly depression and attention-deficit/hyperactivity disorder (ADHD), are a growing concern among U.S. adolescents. Previous research offers inconclusive findings on how these conditions affect educational attainment, and the pathways remain unclear. This paper estimates the causal effects of adolescent depression and ADHD on adult educational attainment using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). To address unobservable confounders, measurement errors, and reverse causality, we employ polygenetic scores (PGSs) and friend suicide attempts as instruments. We find that a one standard deviation increase in ADHD score reduces years of education by 1.3 and the predicted probability of achieving a bachelor's degree by 24.6 percentage points. Depression shows no significant impact on educational attainment. We further identify that the negative impact of ADHD on educational outcomes is primarily attributed to diminished academic performance and impaired self-regulation. School-based interventions and parent management training are potential solutions to mitigate these effects.
Parental health, adolescents' mental distress and non-cognitive skills.
Davillas A, de Oliveira VH, Raftopoulou A
Econ Hum Biol · 2025 Sep · PMID 40460546 · Publisher ↗
Drawing on nationally representative UK data, we explore the association of parental health and disability with mental distress and non-cognitive skills development of adolescents; both self-reported and more objectively...
Drawing on nationally representative UK data, we explore the association of parental health and disability with mental distress and non-cognitive skills development of adolescents; both self-reported and more objectively measured biomarkers are used to capture parental health. Overall, we demonstrate a systematic association between parental health/disability and the non-cognitive skills development of adolescents living in the same household. However, considerable heterogeneity in these associations is observed both between and within mother's and father's health and disability measures. Much less evident is the link between parental health/disability and adolescents' mental distress. Our findings suggest that each parent's health and disability status may be differentially associated with adolescents' non-cognitive skills development.
Sleep hours fall as income rises: Macro and micro evidence on sleep inequality around the world.
Jara C, Pérez F, Wagner R
Econ Hum Biol · 2025 Sep · PMID 40403366 · Publisher ↗
People spend about a third of their lives sleeping. Our paper utilizes detailed time-use data to study sleep inequality by income. Our contribution lies in analyzing this relationship both within and across countries, us...
People spend about a third of their lives sleeping. Our paper utilizes detailed time-use data to study sleep inequality by income. Our contribution lies in analyzing this relationship both within and across countries, using a global sample. At the micro level, we find that full-time male workers in the top income quartile sleep around half an hour less per day than those in the lowest quartile. This qualitative result is robust to various alternative tests and measurement of key variables. At the macro level, the average sleep hours decrease as the country's GDP per capita increases. Interestingly, both our micro and macro estimations, are coherent with an estimated income elasticity of sleep around -0.04. Using this elasticity we replicate the implicit relationships identified in previous single-country studies. Additional results suggest that other leisure activities may be positively correlated to income, such as internet use and social outings, substituting sleep.
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