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

Bibliographic Data

ID21881528
AuthorsSophia Medeiros (0009-0009-2863-5319, Imperial College London, corresponding author), Ruy Coelho (0000-0002-3312-4021, Instituto de Saúde), Rony Coelho (Instituto de Estudos para Políticas de Saúde), Christopher Millett (0000-0002-0793-9884, Imperial College London), Valéria Saraceni (0000-0001-7360-6490, Secretaria Municipal de Saúde), Claudia Medina Coeli (0000-0003-1757-3940, Universidade Federal do Rio de Janeiro), Anete Trajman (0000-0002-4000-4984, Universidade Federal do Rio de Janeiro), Davide Rasella (0000-0002-7260-4386, Universidade Federal da Bahia), Betina Durovni (0000-0002-5555-8015, Fundação Oswaldo Cruz), Thomas Hone (0000-0003-0703-6973, Instituto de Saúde)
Year2023
Volume8
Issue12
Pagese013327
Publication date2023-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-013327
PMID38050408
OpenAlexW4389274056
LanguageEN
Citations received1
References cited90

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

Educational attainment · Environmental health · Ethnic group · Geography · Household income · Inequality · Mental health · Poisson regression · Political science · Population · Psychiatry · Rate ratio · Socioeconomic status · Sociology · Demography · Global Cancer Incidence and Screening · Medicine · Mental Health Treatment and Access · Racial and Ethnic Identity Research · Gerontology