Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States.
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States.
Soc Sci Med. 2018 Feb;199:67-76. doi: 10.1016/j.socscimed.2017.05.047. Epub 2017 May 27.
Residential 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 (2008-2010) to examine the association between economic residential segregation and two major cardio-metabolic risk factors-hypertension 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* 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.
居住隔离是根深蒂固的社会经济和种族不平等的空间表现，被认为是造成健康方面种族不平等的一个根本原因。尽管巴西各地城市地区存在明显的种族化空间不平等，但很少有实证研究检验居住隔离与健康之间的联系，并考虑其对这一环境下种族健康不平等的影响。在本研究中，我们使用巴西成人健康纵向研究（2008-2010 年）的数据，检验经济居住隔离与两个主要的心血管代谢风险因素——高血压和糖尿病之间的关联。我们还检验了这些关联在巴西历史上处于边缘地位的种族群体中是否更强。使用 Getis-Ord 局部 G*统计量为研究定义的社区计算居住隔离程度，并根据 2010 年 IBGE 人口普查的家庭收入数据进行计算。使用多变量逻辑回归模型检验关联。在我们的样本中，黑人和棕色人种更有可能居住在经济上隔离的社区。在考虑了收入、教育和其他人口特征后，我们发现居住在经济隔离程度最高的社区的个体患高血压的可能性要高 26%，患糖尿病的可能性要高 50%，而居住在较富裕地区的个体。尽管生活在高度隔离社区的黑人和棕色人种的高血压和糖尿病患病率高于白人，但我们没有观察到与居住隔离相关的种族差异具有统计学意义。我们的研究结果表明，居住隔离可能是巴西心血管代谢风险因素的一个重要结构性决定因素。此外，黑人与棕色人种系统性和不成比例地暴露于高度隔离的社区，可能意味着这些环境是造成巴西城市环境中心血管代谢风险因素种族不平等的潜在驱动力。
