Racial inequities in self-rated health across Brazilian cities : does residential segregation play a role?
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Date
2022
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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.
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Keywords
Residential segregation, Self-rated health, Brazil, Interaction analysis, Racial health inequities
Citation
GUIMARÃES, J. M. N. et aç. Racial inequities in self-rated health across Brazilian cities : does residential segregation play a role? American Journal of Epidemiology, v. 191, n. 6, p. 1071-1080, 2022. Disponível em: <https://academic.oup.com/aje/article/191/6/1071/6542258?login=true>. Acesso em: 11 out. 2022.