At the intersection of place, race, and health in Brazil: Residential segregation and cardio-metabolic risk factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

a b s t r a c tResidential segregation is the spatial manifestation of entrenched socioeconomic and racial inequities and is considered a fundamental cause of racial inequalities in health. Despite the well-documented racialized spatial inequalities that exist in urban areas throughout Brazil, few empirical investigations have examined the link between residential segregation and health and considered its implications for racial health inequalities in this setting. In the present study, we used data from the Brazilian Longitudinal Study of Adult Health (2008e2010) to examine the association between economic residential segregation and two major cardio-metabolic risk factorsdhypertension and diabetes. We also examined whether associations were stronger for historically marginalized racial groups in Brazil. Residential segregation was calculated for study-defined neighborhoods using the Getis-Ord Local G i * statistic and was based on household income data from the 2010 IBGE demographic census. Multivariable logistic regression models were used to examine associations. In our sample, Blacks and Browns were more likely to live in economically segregated neighborhoods. After taking into account income, education, and other demographic characteristics we found that individuals living in the most economically segregated neighborhoods were 26% more likely to have hypertension and 50% more likely to have diabetes than individuals living in more affluent areas. Although Blacks and Browns living in highly segregated neighborhoods had higher prevalence of hypertension and diabetes compared to Whites, we observed no statistically significant racial differences in the associations with residential segregation. Our findings suggest that residential segregation may be an important structural determinant of cardio-metabolic risk factors in Brazil. Moreover, the systematic and disproportionate exposure of Blacks and Browns to highly segregated neighborhoods may implicate these settings as potential drivers of racial inequalities in cardio-metabolic risk factors in urban settings in Brazil.

Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil

“…Some explanations to this results could be attributed to the effects social/ethnic discrimination leading to alcohol misuse and risk behavior (4,45,46), lower socioeconomic status and social disadvantages such as access to highly concentrated alcoholic drinks during binge drinking episodes (e.g., spirits), and greater poverty or inequitable health care treatment (40,45,(47)(48)(49). Blacks, in Brazil, have been consistently suffered from lower quality healthcare and higher mortality, indicating a strong need for an active and enforced public health agenda toward this minority group (38,(49)(50)(51)(52)(53)(54). Individual facets of socioeconomic status, such as income, educational level, and employment, are important determinants of alcohol use and associated harm (4,55).…”

Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature

“…Three studies had relied only on self-reports on anthropometric, behavioural, biochemical, physiological and diagnostic categories of data, risking for recall bias and misclassifications [13,14,20]. Table 2 summarises the 16 studies reviewed under this section [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Reported studies were mainly from Europe (7/16) and North America (7/16), followed by Oceania (1/16) and South America (1/16).…”

“…Most of these studies were sourced from industrialised nations, except one study from Brazil, [21] a developing nation in South America. All studies reported associations of higher prevalence of CMRFs with greater ASED [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Various measures of the biological proxies of CMRFs reported includ biochemical, anthropometric, physiologic, behavioural and diagnostic categories of data.…”

“…The categories of measures used to calculate ASED in these studies were area-level proportions of: median income; education; occupation; housing; transport; dependent population; social class; social capital; environment; security; family structure; disability; internet access; and insurance coverage. A minimum of one category of these measures were used in all the studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Racial disparities in renal function: the role of racial discrimination. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…Studies that investigated social mobility, income inequalities and educational opportunities among Blacks and Browns in Brazil show that both are in huge disadvantage compared to Whites in all those indexes  18. These minorities are also disproportionately affected by residential segregation in Brazil,19 another clear evidence of structural racism. As a consequence, racial disparities in health are mounting for most leading causes of death, risk behaviours and healthcare use in the country 20–22.…”