Person: Cabieses, Báltica
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Publication Adequate housing as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022(2024) Blukacz, Alice; Oyarte, Marcela; Cabieses, BálticaBackground: Adequate housing is a fundamental right and a social determinant of health. It also represents a historically contentious topic in Latin America. Migratory flows to Chile have become increasingly precarious in the past few years, limiting opportunities for adequate housing, with potential repercussions on the health of international migrants and the general population. This study aims to analyse adequate housing as a social determinant of health among international migrants and locals between 2013 and 2022 in Chile. Methods: Observational cross-sectional study based on repeated versions of the nationally representative Socioeconomic Characterization Survey in Chile. Adequate housing indicators adapted from the United Nations Housing Rights Programme guidelines were analyzed with relation to individual health, distinguishing between the local and international migrant populations. Logistic regression models were fitted for housing indicators with migration as the main independent variable and for short-term and long-term healthcare needs in locals and immigrants with housing as the main dependent variables. Models were adjusted for sociodemographic variables and considered the complex sample design. Results: Descriptive findings indicated higher availability of services and infrastructure among international migrants, and a disadvantage for habitability, location, and affordability by quintiles compared to locals. Logistic regression models, adjusting for demographic variables, revealed significant associations between migration status and overcrowding (OR 6.14, 2022), poor housing materiality (OR 5.65, 2022) and proximity to healthcare centres (OR 1.4, 2022) compared to locals. Experiencing hazardous situations consistently predicted short-term healthcare needs in both migrants (OR = 1.4, 2022) and locals (OR = 2.8, 2022). Overcrowding predicted both long and short-term healthcare needs among locals across the years and long term needs among migrants in 2013 and 2015. Conclusions: We found significant inequities in adequate housing between migrant populations and locals in Chile, and some inequities among both populations based on structural socioeconomic deprivation. Experiencing hazardous situations emerged as a social determinant of health among international migrants in 2022, potentially suggesting growing challenges related to social exclusion in urban areas. However, limitations such as exclusion criteria of the survey and sample sizes for data on the migrant population potentially suggest that housing challenges and their impact on health are underestimated.Publication Breast cancer diagnosis and staging in Chile: A nonrandomized survey-based study to assess frequency and delays(2024) Campaña, Carla; Oyarte, Marcela; Cabieses, Báltica; Obach, AlexandraIntroduction: Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods: Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results: A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions: Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.Publication Education as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Díaz, JanepsyBackground: Education is a recognised social determinant of health and interacts with other determinants including employment and income. International migration may disrupt these interactions. Education in Chile reflects wider socioeconomic inequalities and in the last decade, it has welcomed an increasing number of migrants. Objective: To analyse education as a social determinant of health among international migrants and locals between 2013 and 2022. Methods: Observational cross-sectional study based on five versions of the CASEN survey. Education, employment, and income were analysed in relation to healthcare needs for both populations and logistic regression models were estimated for each year. For 2022, the interactions between education and employment were explored in relation to healthcare needs. Results: International migrants showed a higher education level and employment rate than Chileans, and a smaller proportion reported healthcare needs. After adjusting for demographic and socioeconomic factors, locals aged 19–25 and 26–59 were more likely to report healthcare needs compared to international migrants across multiple years. The effects of education, employment, and income on healthcare needs among locals and international migrants showed fluctuating ORs without marked trends. In 2022, significant differences in healthcare needs were observed among migrants and locals based on interactions between education and employment, with non-overlapping confidence intervals particularly among unemployed, less-educated youth, middle-aged migrants with incomplete basic education, and older individuals. Conclusions: This study provides an overview of education as a social determinant of health among international migrants and locals for the last decade and call for targeted in-depth analyses on the topic.