Racial Inequities in Self-Rated Health Across Brazilian Cities: Does Residential Segregation Play a Role?

Abstract

Racial health inequities may be partially explained by area-level factors such as residential segregation. In this cross-sectional study, using a large, multiracial, representative sample of Brazilian adults (n = 37,009 individuals in the 27 state capitals; National Health Survey (Pesquisa Nacional de Saúde), 2013), we investigated 1) whether individual-level self-rated health (SRH) (fair or poor vs. good or better) varies by race (self-declared White, Brown, or Black) and 2) whether city-level economic or racial residential segregation (using dissimilarity index values in tertiles: low, medium, and high) interacts with race, increasing racial inequities in SRH. Prevalence of fair or poor SRH was 31.5% (Black, Brown, and White people: 36.4%, 34.0%, and 27.3%, respectively). Marginal standardization based on multilevel logistic regression models, adjusted for age, gender, and education, showed that Black and Brown people had, respectively, 20% and 10% higher prevalence of fair or poor SRH than did White people. Furthermore, residential segregation interacted with race such that the more segregated a city, the greater the racial gap among Black, Brown, and White people in fair or poor SRH for both income and race segregation. Policies to reduce racial inequities may need to address residential segregation and its consequences for health.

The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States

“…Ethnoracial health inequities in Brazil may persist in the U.S. context and should be considered carefully. Evidence from an epidemiological study using a nationally representative sample in Brazil indicated that Brazilians who self‐identify as “Black” or “Brown” have, respectively, 20% and 10% higher prevalence of fair or poor self‐rated health than Brazilians who self‐identify as “White.” 58 Similarly, other epidemiological evidence indicates that Black Brazilian individuals generally have higher rates of multimorbidity, lower rates of public health care utilization, and a higher risk of death than White Brazilian individuals 59 . These ethnoracial inequities persist following statistical adjustment for socioeconomic indicators, suggesting that race/ethnicity may independently affect health outcomes in Brazil, particularly the worse outcomes for the Black Brazilian population 59 .…”

Income Segregation, Conditional Cash Transfers, and Breast Cancer Mortality Among Women in Brazil

“…Our study also found that Black women had a 10% higher risk of breast cancer mortality than White women, which is consistent with previous Brazilian research 29,30 and may be explained by barriers to accessing health care and discrimination shaped by structural racism. This may be potentially magnified by living in more segregated areas 31 and deserves further exploration.…”

Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil

“…Regarding studies conducted in Brazil, a cohort study from the state of São Paulo, showed that race is an independent risk factor for premature birth, even after adjusting for household income and maternal education 29 . Racial differences in premature birth can be explained by the socioeconomic disadvantages experienced by black women since these women face greater social and economic challenges than white women 30,31 . Yet these differences can be influenced by other factors, such as difficulty in accessing prenatal care caused by institutional racism 32 .…”