Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010-2016.

Autor:	Medeiros S; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK sophia.medeiros21@imperial.ac.uk., Coelho R; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil., Millett C; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisboa, Portugal., Saraceni V; Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil., Coeli CM; Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Trajman A; Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Rasella D; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil., Durovni B; Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Hone T; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2023 Dec 02; Vol. 8 (12). Date of Electronic Publication: 2023 Dec 02.
DOI:	10.1136/bmjgh-2023-013327
Abstrakt:	Introduction: Mental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This study investigates racial and socioeconomic inequalities in primary healthcare usage, hospitalisation and mortality for mental health disorders in Rio de Janeiro, Brazil. Methods: A cohort of 1.2 million low-income adults from Rio de Janeiro, Brazil with linked socioeconomic, demographic, healthcare use and mortality records was cross-sectionally analysed. Poisson regression models were used to investigate associations between self-defined race/colour and primary healthcare (PHC) usage, hospitalisation and mortality due to mental disorders, adjusting for socioeconomic factors. Interactions between race/colour and socioeconomic characteristics (sex, education level, income) explored if black and pardo (mixed race) individuals faced compounded risk of adverse mental health outcomes. Results: There were 272 532 PHC consultations, 10 970 hospitalisations and 259 deaths due to mental disorders between 2010 and 2016. After adjusting for a wide range of socioeconomic factors, the lowest PHC usage rates were observed in black (adjusted rate ratio (ARR): 0.64; 95% CI 0.60 to 0.68; compared with white) and pardo individuals (ARR: 0.87; 95% CI 0.83 to 0.92). Black individuals were more likely to die from mental disorders (ARR: 1.68; 95% CI 1.19 to 2.37; compared with white), as were those with lower educational attainment and household income. In interaction models, being black or pardo conferred additional disadvantage across mental health outcomes. The highest educated black (ARR: 0.56; 95% CI 0.47 to 0.66) and pardo (ARR: 0.75; 95% CI 0.66 to 0.87) individuals had lower rates of PHC usage for mental disorders compared with the least educated white individuals. Black individuals were 3.7 times (ARR: 3.67; 95% CI 1.29 to 10.42) more likely to die from mental disorders compared with white individuals with the same education level. Conclusion: In low-income individuals in Rio de Janeiro, racial/colour inequalities in mental health outcomes were large and not fully explainable by socioeconomic status. Black and pardo Brazilians were consistently negatively affected, with lower PHC usage and worse mental health outcomes. Competing Interests: Competing interests: BD was Undersecretary of Health Promotion, Surveillance and Primary Care at the Secretaria Municipal de Saúde, Rio de Janeiro when this project was conceived. VS is a Coordinator of Health Situation Analysis in the Health Surveillance Department, at the Secretaria Municipal de Saúde, Rio de Janeiro. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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