Economics And Human Biology[JOURNAL]
Sun
200 papers
The impact of waiting time on patient outcomes: The case of joint replacement surgery.
Gaughan J, Santos R, Siciliani L
Econ Hum Biol · 2026 Jun · PMID 42398304 · Publisher ↗
Waiting time for elective treatments is a major health policy issue in many OECD countries that was exacerbated by COVID-19. We test whether waiting times from referral to surgery reduces post-operative health and resour...
Waiting time for elective treatments is a major health policy issue in many OECD countries that was exacerbated by COVID-19. We test whether waiting times from referral to surgery reduces post-operative health and resource use for patients in need of a hip or knee replacement in England. We employ a large administrative dataset for 2015/16-2022/23. We use an instrumental-variable regression approach based on congestion while controlling for a rich set of patient characteristics and hospital fixed effects. We find that, for public hospitals in the pre-COVID period (April 2015-January 2020), referral-to-treatment waiting times do not have a statistically significant effect on post-operative health for either hip or knee replacement (as measured by Oxford Hip or Knee Score) or the probability of being readmitted within 28 days following discharge. However, for public hospitals, one additional month of waiting instead increases length of stay by 0.075 days (2.06%) for hip replacement but has no effect for knee replacement. For private hospitals, we do not find an effect between referral-to-treatment waiting times and any of the outcomes. In heterogeneity analysis, we generally do not find differential effects of waiting on different groups (by gender, ethnicity, income and education deprivation, pre-operative health). In the COVID-19 period (April 2020-March 2023), we generally do not find an effect of waiting times on any of the outcomes.
Extreme temperatures and non-work at work.
Belloc I, Gimenez-Nadal JI, Molina JA
Econ Hum Biol · 2026 Jul · PMID 42398303 · Publisher ↗
Understanding the determinants of worker effort is central to Economics, as even small changes in productivity can have significant implications for economic growth and labor market performance. This study examines the r...
Understanding the determinants of worker effort is central to Economics, as even small changes in productivity can have significant implications for economic growth and labor market performance. This study examines the relationship between extreme temperatures and work effort-proxied by non-work time while at the workplace-using data from the American Time Use Survey (ATUS) for the period 2003-2019. Results indicate that extremely hot days (≥ 100ºF) are related to increased time spent at work not working, particularly among women and hourly workers. On these days, women spend 4.38 more minutes at work not working compared to comfortable temperature days. Men, by contrast, do not exhibit significant changes in non-work time at work. Furthermore, the results align with increased worker bargaining power during economic expansions, which facilitates labor supply adjustments on extremely hot days, and with hypotheses regarding adaptation and acclimation to high temperatures in warmer counties. These findings underscore the relevance of temperature as a determinant of worker effort, reveal a previously overlooked margin of labor adjustment, and highlight the moderating role of schedule flexibility in shaping behavioral responses to environmental stressors.
Permanent income shocks and suicidal ideation: Evidence from South Korea.
Wang P
Econ Hum Biol · 2026 Jun · PMID 42372592 · Publisher ↗
Who falls into suicidal ideation when income drops? Drawing on the Korea Welfare Panel Study covering 2011 to 2023 and decomposing income into permanent and transitory components, I find the answer is highly concentrated...
Who falls into suicidal ideation when income drops? Drawing on the Korea Welfare Panel Study covering 2011 to 2023 and decomposing income into permanent and transitory components, I find the answer is highly concentrated. Transitory income fluctuations leave ideation almost unchanged, while permanent declines are associated with strong and durable increases in ideation, extending the permanent income logic to mental health. Households suffering persistent income declines and renters or the initially poor bear nearly all of the cost: renters carry a gradient roughly five times that of homeowners, and the initially poor several times that of the better-off. Material hardship and depressive symptoms together absorb the bulk of the income-ideation link. Administrative regional records on suicide deaths reproduce the negative income gradient and reveal a pooled male mortality response about six times the female one, even though ideation itself is more prevalent in women, a layered cognition-behaviour pattern with sex-symmetric thoughts but male-predominant lethality. The income-to-ideation gradient is markedly steeper among heavier problem-drinkers: an alcohol-disinhibition effect that operates across both sexes at the cognitive level, while the step from ideation to lethal behaviour falls predominantly on men. Together the results identify housing tenure and initial deprivation as the pressure points along which the income-mental-health gradient bites, and where social protection has the greatest scope to act.
Mental health and labour supply: Evidence from China.
Lander D, Zhao X
Econ Hum Biol · 2026 Jun · PMID 42365730 · Publisher ↗
This paper studies the effect of mental health on employment and labour-force participation in China using nationally-representative China Family Panel Studies (CFPS) data. Utilising CFPS waves 2012, 2016, and 2018, we c...
This paper studies the effect of mental health on employment and labour-force participation in China using nationally-representative China Family Panel Studies (CFPS) data. Utilising CFPS waves 2012, 2016, and 2018, we construct consistent measures of labour supply and mental health using the Center for Epidemiological Studies Depression (CES-D) scale. The panel structure enables us to control for unobservable time-invariant individual heterogeneity, in contrast to most prior studies from developing countries. To address concerns about reverse causality and omitted time-varying factors, we complement fixed-effects estimates with (i) Oster (2019) coefficient-stability bounds and (ii) robustness checks using respondents' reported reasons for non-employment. Our estimates reveal that experiencing severe depressive symptoms reduces the likelihood of employment and labour-force participation by, on average, 1.8-1.9 and 1.3-1.4 percentage points, respectively. These estimates are similar in magnitude to those from advanced economies, despite China substantially differing in terms of its development, labour market structure, and mental health provisions. Within China, the estimated effects are concentrated almost exclusively among older male workers, with limited evidence of comparable impacts for the broader prime-age workforce.
Agrarian reform and child stunting: Evidence from two land allocation strategies.
Gachet N
Econ Hum Biol · 2026 Jun · PMID 42361769 · Publisher ↗
Stunting remains a major development challenge in many countries, including Ecuador. In this paper, I examine whether agrarian reform policies implemented during the 1960s and 1970s help explain long-run patterns of chil...
Stunting remains a major development challenge in many countries, including Ecuador. In this paper, I examine whether agrarian reform policies implemented during the 1960s and 1970s help explain long-run patterns of child stunting. The Ecuadorian reform relied on two distinct land allocation strategies: Public land transfers (PLT), designed to promote frontier settlement, and expropriation, aimed at redistributing land from large estates. Combining household survey data with historical maps and administrative records, I estimate the long-run relationship between these policies and child stunting by exploiting historical variation in land allocation across parishes. I find that areas exposed to PLT exhibit significantly lower rates of child stunting, while expropriation shows no robust association. Across specifications, PLT exposure is associated with stunting rates that are 3-17 percent lower relative to the mean. Cohort evidence further indicates that the relationship is stronger for mothers plausibly exposed to PLT during early childhood. Consistent with this pattern, mothers from more exposed PLT cohorts attained higher levels of education, suggesting that maternal human capital may be one channel linking frontier settlement policies to lower child stunting.
Rural health disadvantages in the United States: Evidence from nationally representative data.
Restrepo BJ, Dobis EA, Low SA … +1 more , Thomas KL
Econ Hum Biol · 2026 Jun · PMID 42341364 · Publisher ↗
A gap in mortality rates between rural and urban areas emerged in the late 1990s as rural residents began dying at a higher rate than their urban counterparts. This mortality gap has been widening ever since. The growing...
A gap in mortality rates between rural and urban areas emerged in the late 1990s as rural residents began dying at a higher rate than their urban counterparts. This mortality gap has been widening ever since. The growing mortality gap is pronounced among prime working-age adults (ages 25-54), which has important implications for rural health, productivity, and economic development. Despite the heightened mortality rates in rural areas in recent decades, there is still a limited understanding of the health-related mechanisms fueling this worsening rural-urban mortality disparity. Using nationally representative data from the 1999-2000-2017-March 2020 cycles of the National Health and Nutrition Examination Survey, we combine individual-level data, including biomarkers, and place-based characteristics to create a comprehensive dataset spanning 20 years. In a descriptive analysis, we use linear regression models to estimate the magnitude of rural-urban gaps in health behaviors and outcomes-or mortality risk indicators-for the overall adult and prime working-age populations. We document a suite of rural health disadvantages, which may be informative for understanding the growing rural longevity gap. These disadvantages are often attenuated and no longer statistically significant after accounting for county-level characteristics. A complementary decomposition analysis indicates that county characteristics account for a larger share of the variation in health measures than rural-urban status. Our results can inform decision-makers aiming to improve rural health and economic outcomes and may spur further research using biomarker data alongside place-based characteristics.
Beyond average health: Urban-rural disparities in the distribution of self-perceived health.
Leporatti L, Levaggi R, Pontarollo N
Econ Hum Biol · 2026 Jun · PMID 42320258 · Publisher ↗
Urban and rural areas differ along multiple dimensions. Urban contexts typically offer better access to services and facilities, while in rural areas access to even essential services may be more limited. At the same tim...
Urban and rural areas differ along multiple dimensions. Urban contexts typically offer better access to services and facilities, while in rural areas access to even essential services may be more limited. At the same time, rural environments often provide higher environmental quality, greater perceived safety and stronger social ties. How these contrasting features translate into self-perceived health and health disparities remains an open and policy-relevant question. This paper examines spatial disparities in self-perceived health by analysing both average outcomes and within-context inequality across municipality types. Using original survey data from an Italian metropolitan area, we compare health disparities across large and small municipalities as well as coastal and rural areas. Results show that differences in average self-perceived health are relatively modest, whereas health dispersion is significantly lower in small and rural municipalities. These gaps are only partially explained by observable characteristics and are largely driven by heterogeneous returns to psychosocial factors and perceived local services. The findings highlight the importance of adopting a distributional perspective and suggest that improvements in the quality of local services may play a key role in reducing spatial health inequalities.
Does education improve health literacy? Evidence from China's compulsory education law.
Lyu J, Qin X, Sun R
Econ Hum Biol · 2026 Jun · PMID 42320257 · Publisher ↗
This study examines the causal impact of education on health literacy using a newly collected dataset from China that merges the 2020 China Family Panel Studies (CFPS) with our self-designed Chinese Health Literacy Surve...
This study examines the causal impact of education on health literacy using a newly collected dataset from China that merges the 2020 China Family Panel Studies (CFPS) with our self-designed Chinese Health Literacy Survey (CHLS). To address endogeneity concerns, we exploit the staggered implementation of the 1986 Compulsory Education Law as an instrumental variable. We find that one additional year of education increases health literacy by 17.3% of a standard deviation. This paper provides the first causal evidence linking education to directly measured health literacy, contributing to both the economics and public health literature.
Explaining birth order effects on child nutrition: Evidence from Kyrgyzstan.
Issabekova D, Bazarkulova D
Econ Hum Biol · 2026 Jun · PMID 42285008 · Publisher ↗
This paper examines the effects of birth order on child nutrition in Kyrgyzstan, a lower-middle-income country in Central Asia characterized by a Soviet legacy of universal healthcare, relatively high fertility, widespre...
This paper examines the effects of birth order on child nutrition in Kyrgyzstan, a lower-middle-income country in Central Asia characterized by a Soviet legacy of universal healthcare, relatively high fertility, widespread multigenerational co-residence, and growing economic vulnerability. Using nationally representative data from three waves of the Kyrgyzstan Multiple Indicator Cluster Survey and a mother fixed-effects design, we find that later-born children have worse nutritional outcomes than firstborns, with differences most pronounced and robust for height-for-age (HAZ). Differences in weight-for-age (WAZ) are smaller and less precisely estimated, while weight-for-height (WHZ) shows no systematic variation. Subgroup analyses suggest that birth order disparities vary descriptively across household environments, while formal tests generally do not indicate statistically significant differences across most dimensions. Although grandmother co-residence and higher household head's education are associated with smaller birth order penalties, they do not fully eliminate birth order disparities.
Cold winter, desperate heart: Experience of Great Famine and drinks.
Liu B, Shu M, Liu F … +3 more , Wang S, Tian J, Ai Z
Econ Hum Biol · 2026 Jun · PMID 42285007 · Publisher ↗
Famine is a significant and far-reaching challenge for developing countries. This study focuses on the impact of the Great Famine in China around 1960 (1959-1961) on citizens' long-term drinking behavior, health, and soc...
Famine is a significant and far-reaching challenge for developing countries. This study focuses on the impact of the Great Famine in China around 1960 (1959-1961) on citizens' long-term drinking behavior, health, and socio-economic consequences. We use the CFPS panel data from 2012 to 2020 as a benchmark for regression, employing multiple regression methods including double fixed effects, Poisson fixed effects, and logistic regression fixed effects to find a significant relationship between experiencing famine and the risk of alcohol consumption. However, cohort heterogeneity analysis reveals that this effect is driven entirely by individuals who were already adults during the famine (born before 1941), while those exposed in utero or during infancy (born 1959-1961) show no significant long-term increase in drinking risk. The connection between experiencing the Great Famine as an adult and the risk of alcohol consumption may stem from the deep psychological trauma it causes, similar to how war victims use alcohol abuse to escape pain. By introducing the CHARLS database to explore eight health consequences, we found that frequent alcohol consumption is significantly associated with adverse health outcomes. By combining the CFPS questionnaire to evaluate economic and social consequences, we found that frequent alcohol consumption can negatively affect citizens' trust in various aspects and reduce their sense of happiness. Additionally, it was found that education has a corrective effect and can alleviate the despair caused by experiencing famine, providing a possible solution to mitigate the negative psychological impact of famine.
Universal health insurance and health behavior: Evidence from the elderly in Taiwan.
Shen Y
Econ Hum Biol · 2026 Jun · PMID 42269413 · Publisher ↗
This study investigates the effect of universal health insurance on the health behavior of the elderly in Taiwan. Using a difference-in-differences approach, I show that universal health insurance does not lead to ex-ant...
This study investigates the effect of universal health insurance on the health behavior of the elderly in Taiwan. Using a difference-in-differences approach, I show that universal health insurance does not lead to ex-ante moral hazard for elderly Taiwanese men or women. Instead, it reduces certain risky health behaviors among elderly women, such as drinking and smoking. Moreover, it reduces the likelihood of engaging in more than two risky behaviors. The effect varies significantly across health behaviors by education level and insurance type. My findings suggest that universal health insurance has potentially beneficial impacts on risky health behaviors, such as drinking and smoking, among elderly Taiwanese women, which may be important for policymakers in other countries and territories.
Antibiotic resistance, drug prices, and entry.
Jia M, Ma CA
Econ Hum Biol · 2026 May · PMID 42247974 · Publisher ↗
Antibiotics lose power to kill microbes through excessive use, commonly known as antibiotic resistance, which is modeled by future cost increase from current use. The first best incorporates future cost externality due t...
Antibiotics lose power to kill microbes through excessive use, commonly known as antibiotic resistance, which is modeled by future cost increase from current use. The first best incorporates future cost externality due to current consumption. Resistance and consumer welfare deviate from first best in various market structures. Low prices under competition lead to high consumption and resistance. Competitive managed-care plans use rationing contracts, which partially internalize resistance cost externality by restricting use. A drug monopolist fully internalizes the externality, but sets a high price. We derive necessary and sufficient conditions for higher consumer surplus under monopoly than competition. Facing a potential entrant, an incumbent may consider entry deterrence and accommodation. To deter entry, the incumbent reduces current sales to lower future cost; this alleviates antibiotic resistance. Entry accommodation gives rise to two countervailing effects. First, incumbent and entrant will share the market. The incumbent has less incentive to internalize the cost effect, so raises production and exacerbates resistance. Second, the incumbent makes more profit when its future cost is low, so reduces production and mitigates resistance.
Economic roots of cognitive decline: Tracing early-life shocks to late-life health.
Madia JE, Moscone F, Nicodemo C … +2 more , Orso CE, Tealdi C
Econ Hum Biol · 2026 May · PMID 42214253 · Publisher ↗
This study investigates the long-term associations between early-life economic shocks and cognitive decline in later years, emphasizing the mediating roles of education, unemployment, and health-related factors. Using da...
This study investigates the long-term associations between early-life economic shocks and cognitive decline in later years, emphasizing the mediating roles of education, unemployment, and health-related factors. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we examine the relationship between childhood economic adversity, such as parental job loss, poverty, and limited access to educational material at home, and cognitive performance in old age. Applying the Karlson-Holm-Breen (KHB) method, we assess how economic and health factors throughout life mediate this association. Our findings indicate that early economic hardship is strongly linked to poorer cognitive outcomes, including lower performance in memory and verbal fluency. Education plays a crucial mediating role, accounting for 20%-25% of the total association, while unemployment and health issues, such as chronic disease and mental health conditions, are associated with cognitive outcomes to a lesser extent. These results underscore the relevance of early interventions, particularly in education and labour market stability, in addressing the long-term cognitive correlates of childhood economic adversity.
Heterogeneous returns to antenatal care: Evidence from childhood immunization in Senegal.
Kolani T
Econ Hum Biol · 2026 May · PMID 42176395 · Publisher ↗
Antenatal care (ANC) serves both as a medical input and as a source of health information in the child health production function. We use seven waves of the Senegal Demographic and Health Surveys, matched to regional hea...
Antenatal care (ANC) serves both as a medical input and as a source of health information in the child health production function. We use seven waves of the Senegal Demographic and Health Surveys, matched to regional health-facility data, to estimate the effect of ANC adherence on childhood vaccination outcomes. We address endogeneity arising from unobserved heterogeneity in ANC utilization using a two-stage copula-based control-function approach. We find that ANC adherence has no effect on the composite measure of full immunization, but significantly increases uptake of two injectable vaccines, the three-dose diphtheria-pertussis-tetanus vaccine (DTP3) and measles, by 8.2 % and 6.3 % points, respectively. These effects are concentrated among mothers with no schooling or only primary education. We also find no robust evidence that the marginal returns to ANC adherence differ by child sex, fertility intention, or ethnicity.
Sick and cold? Evidence on the dynamic interplay between energy poverty and self-perceived health.
Budrìa S, Donni PL, Zucchelli E
Econ Hum Biol · 2026 May · PMID 42139841 · Publisher ↗
Although a close association between energy poverty and ill-health has been widely documented, robust evidence on the dynamic and bidirectional nature of this relationship remains limited. We employ a dynamic latent clas...
Although a close association between energy poverty and ill-health has been widely documented, robust evidence on the dynamic and bidirectional nature of this relationship remains limited. We employ a dynamic latent class model on rich longitudinal data from the Household, Income, and Labour Dynamics in Australia Survey to uncover patterns of dynamic interdependence between energy poverty and self-perceived ill-health. Our approach integrates key modelling features, such as state dependence and time-varying unobserved heterogeneity, while also revealing and quantifying mechanisms of joint dependence over time. Unlike previous studies, our model shows that although energy poverty and ill-health seem to mutually influence each other, the effect of ill-health on energy poverty appears to be comparatively larger, suggesting that ill-health might be a stepping stone to energy poverty. In addition, we identify three main types of individuals corresponding to different socioeconomic profiles, varying levels of vulnerability to changes in energy prices and distinct geographical distributions. We complement this analysis with a simulation exercise estimating the size and effectiveness of government transfers required to lift individuals out of energy poverty within each latent population groups. Overall, these findings may indicate the need for targeted interventions rather than an exclusive reliance on energy subsidies.
Limiting antidepressant prescriptions and suicide risk: Evidence from South Korea.
Oh H, Smith TA
Econ Hum Biol · 2026 May · PMID 42116247 · Publisher ↗
South Korea has the highest suicide rate in the Organization for Economic Co-operation and Development (OECD). In 2002, the Ministry of Health and Welfare of South Korea implemented a policy limiting antidepressant presc...
South Korea has the highest suicide rate in the Organization for Economic Co-operation and Development (OECD). In 2002, the Ministry of Health and Welfare of South Korea implemented a policy limiting antidepressant prescriptions to 60 days in non-psychiatric clinics, aiming to prevent drug misuse. This study examines how this policy affected suicidal thoughts and attempts among patients with chronic disease. We use patients with chronic conditions, because they frequently receive antidepressants in non-psychiatric clinics, making them more vulnerable to these prescription limits. We use two approaches. First, a synthetic control method with country-level data shows a significant increase in suicide rates in South Korea following the policy compared to synthetic counterparts. Second, a difference-in-differences analysis with individual-level data shows a 0.4 percentage point increase in suicide attempts among those with chronic disease, and a 2.2 percentage point increase among those who also reported suicidal thoughts. These correspond to 36% and 51% increases relative to their pre-policy baselines. The analysis reveals that the policy's intention-to-treat effects on suicidal behaviors vary across demographic groups, with larger effects observed among divorced individuals, those with lower levels of education, and individuals in lower income quartiles. These findings point to the potential unintended consequences of restrictions on antidepressant prescriptions that can lead to adverse health outcomes among vulnerable population.
Silver bullet? The effect of mask mandates on COVID-19 cases.
Denkyirah EK, March RJ
Econ Hum Biol · 2026 May · PMID 42105664 · Publisher ↗
We employ a difference-in-difference (DID) approach developed by Callaway and Sant'Anna (2021) with doubly robust inverse probability weighting estimator to assess the relationship between mask mandates and positive COVI...
We employ a difference-in-difference (DID) approach developed by Callaway and Sant'Anna (2021) with doubly robust inverse probability weighting estimator to assess the relationship between mask mandates and positive COVID-19 cases per 100,000. We find a statistically significant negative relationship between mask mandates and COVID-19 cases using monthly county-level data. We further find ATTs ranging between 87.48 and 92.56 fewer positive cases per 100,000. Our analysis provides insights into future public health responses to infectious disease outbreaks and policy efforts to address public health crises more broadly.
The height of Swiss mercenaries, c. 1725 - c. 1865.
Chambru C, Hediger S, Metzler J … +1 more , Woitek U
Econ Hum Biol · 2026 May · PMID 42102429 · Publisher ↗
This paper traces the evolution of the biological standard of living in Switzerland using anthropometric evidence from approximately 22,000 Swiss mercenaries born between c. 1725 and c. 1865. The data reveal a marked dec...
This paper traces the evolution of the biological standard of living in Switzerland using anthropometric evidence from approximately 22,000 Swiss mercenaries born between c. 1725 and c. 1865. The data reveal a marked decline in average height beginning in the 1770s and persisting throughout the first half of the nineteenth century, with no clear signs of recovery. Mercenaries born before 1800 were on average 2.5 cm taller than those born thereafter, pointing to a sustained deterioration in net nutritional status and health conditions. We account for variations in recruitment standards by estimating minimum height thresholds and potential selection effects across regiments. Although the mercenary sample represents a specific population group, the results are consistent with the economic difficulties of the late eighteenth century, the strains associated with early industrialization, and existing anthropometric evidence from Switzerland and other parts of Europe. Together, the findings suggest a prolonged decline in biological living standards during a critical phase of economic and social transformation.
The impact of heat and cold on mortality and life expectancy in Europe, 2015-2024.
Hajdu T
Econ Hum Biol · 2026 May · PMID 42096825 · Publisher ↗
This paper analyzes the effects of temperatures on mortality and life expectancy using data on 40 million deaths in 28 European countries between 2015 and 2024. The findings indicate that both cold and hot temperatures i...
This paper analyzes the effects of temperatures on mortality and life expectancy using data on 40 million deaths in 28 European countries between 2015 and 2024. The findings indicate that both cold and hot temperatures increase mortality rates, with cold having a stronger overall effect. Heat-related mortality tends to be immediate, whereas cold-related effects are more delayed and prolonged. Climate and income are key moderators: cold-related mortality is higher in warmer regions, heat-related mortality is higher in colder regions, and the effects of cold are stronger at lower income levels. The study also shows that the number of deaths in 2015-2024 would have been higher under the climate conditions of 1950-1979. The shift in the temperature distribution increased mortality during the warmest months but reduced mortality during the colder months, yielding a net decrease of more than 900,000 deaths over the 2015-2024 period. This reduction corresponds to an average increase in life expectancy at birth of 0.195 years.
County-level income inequality and suicide in the United States.
Frank MW, Gonzalez F
Econ Hum Biol · 2026 May · PMID 42054724 · Publisher ↗
We introduce a new county-level panel of annual U.S. income inequality measures for 2010-2021 and make the dataset publicly available with planned annual updates. The panel harmonizes upper-tail indicators (e.g., Top 10%...
We introduce a new county-level panel of annual U.S. income inequality measures for 2010-2021 and make the dataset publicly available with planned annual updates. The panel harmonizes upper-tail indicators (e.g., Top 10%, Top 5%, and Top 1% income shares) with full-distribution indices, enabling comparisons that standard sources do not permit. The panel provides the first county-level estimates of top income shares, previously unavailable for the United States. Linking these measures to suicide mortality and rich covariates, we find that higher upper-tail income concentration is associated with higher suicide mortality in nonmetropolitan and micropolitan counties, whereas distribution-wide indices (e.g., the Gini) exhibit weaker or null associations. A proxy for firearm availability is positively related to suicide rates, and the uninsured rate is a significant risk factor even after controlling for earnings, unemployment, population scale, and demographics. Results are robust to alternative population weights, clustering, lags, rural-urban definitions, and expanded control sets.
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