Am J Epidemiol. 2022 May 20;191(6):1071-1080. doi: 10.1093/aje/kwac001.
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.
种族健康不平等可能部分可以通过居住隔离等区域因素来解释。在这项横断面研究中，使用了来自巴西成年人的大型、多种族、代表性样本（27 个州首府的 n = 37009 人；全国健康调查（Pesquisa Nacional de Saúde），2013 年），我们调查了 1）个体层面的自评健康（SRH）（一般或较差与良好或更好）是否因种族（自我认定的白人、棕色或黑人）而异，2）城市层面的经济或种族居住隔离（使用三分位的不相似指数值：低、中、高）是否与种族相互作用，从而增加 SRH 方面的种族不平等。一般或较差 SRH 的患病率为 31.5%（黑人、棕色人和白人分别为 36.4%、34.0%和 27.3%）。基于多水平逻辑回归模型的边缘标准化，调整年龄、性别和教育因素后，黑人与棕色人自评健康一般或较差的比例分别比白人高 20%和 10%。此外，居住隔离与种族相互作用，一个城市的居住隔离程度越高，收入和种族隔离方面的黑人、棕色人和白人之间的 SRH 差距就越大。减少种族不平等的政策可能需要解决居住隔离及其对健康的影响。
