Mortality by skin color/race, urbanicity, and metropolitan region in Brazil

Abstract

This study investigated the mortality rate distribution in Brazilian cities based on skin color/race and according to level of urbanicity and aggregation into metropolitan region (MR) in 2010. The age-adjusted all-cause mortality rate (AMR) was calculated according to skin color/race (white, brown, or black). Municipalities were used as analysis units and classified into six categories: Rural within MR; Rural outside MR; ‘Rurbano’ within MR; ‘Rurbano’ outside MR; Urban within MR and Urban outside MR. Racial inequality intensified in line with increasing urbanicity level, from rural to urban areas. However, these differences depended on how the city was aggregated to MR, thus suggesting that the mortality spatial structure was based on skin color or race in these locations. The black population presented the worst AMR risk, mainly in cities outside MR. In addition, it was found that there was an excess mortality in the black population as compared with white people. Mortality-related racial inequalities were associated with urbanicity and MR level. They were also dependent on a complex combination of risk factors in these areas. City categorization may serve as an intervention point to reduce racial inequalities in health among populations in Brazilian cities.