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Racial density and the socioeconomic, demographic and health context in Brazilian cities in 2000 and 2010

ABSTRACT:

Introduction:

Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted.

Method:

Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category.

Results:

The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities.

Discussion:

Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities.

Conclusion:

The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.

Keywords:
Health status disparities; Ethnic groups; Cities; Mortality; Race relations

RESUMO:

Introdução:

A densidade racial ainda não foi explorada nos estudos sobre desigualdades raciais no Brasil. Este estudo identifica categorias de densidade racial para as cidades brasileiras e descreve a situação de vida e saúde nessas categorias nos anos dos Censos Demográficos de 2000 e 2010.

Método:

Estudo ecológico em que a informação de cor/raça nos dois últimos censos foi usada para calcular a densidade racial (proporçãode pessoas do mesmo grupo racial) nas cidades brasileiras em cada ano. Criaram-se quatro categorias de densidade racial (parda; mistos, mas com maioria negra; branca; e mistos, mas com maioria branca).Paraquais foram descritos indicadores socioeconômicos, demográficos e de saúde.

Resultados:

As categorias de densidade racial captaram desigualdades importantes ao longo dos censos e apontaram a permanência de piores condições de vida e saúde nas cidades formadas por pardos e mistos, mas com maioria negra, e melhores onde predominaram brancos. As cidades predominadas por pardos e mistos, mas com maioria negra, em relação às demais, apresentam, nos dois censos, estrutura etária mais jovem, piores índices de desenvolvimento humano, maior vulnerabilidade social, concentração de renda, mortalidade infantil e prematura (< 65 anos) e menor esperança de vida de seus moradores.

Discussão:

Semelhantemente a outros países, a densidade racial espelhou desigualdades na situação de vida e saúde no Brasil, bem como defasagem temporal entre suas cidades.

Conclusão:

As categorias de densidade racial podem contribuir para os estudos sobre a epidemiologia social e sobre as relações raciais no país.

Palavras-chave:
Desigualdades em saúde; Grupos étnicos; Cidades; Mortalidade; Relações raciais

INTRODUCTION

Most research on racial inequalities uses color/race categories to establish, individually, social differentiation criteria11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,22. Muniz JO. Preto no branco? Mensuração, relevância e concordância classificatória no país da incerteza racial. Dados 2012; 55(1): 251-82. http://dx.doi.org/10.1590/S0011-52582012000100007
http://dx.doi.org/10.1590/S0011-52582012...
and assess exposure to risk factors variation, protection and health outcomes11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
; however, the aggregate analysis and spatial distribution of racial categories through the racial density construct11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,22. Muniz JO. Preto no branco? Mensuração, relevância e concordância classificatória no país da incerteza racial. Dados 2012; 55(1): 251-82. http://dx.doi.org/10.1590/S0011-52582012000100007
http://dx.doi.org/10.1590/S0011-52582012...
is still little explored.

Racial density indicates the proportion of an ethnic-racial group within an area and is used to verify the relationship between contextual issues such as life materials33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
,77. Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
https://doi.org/10.1016/j.healthplace.20...
and health of people living in areas with high concentration of the same racial group to which they belong 55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
,77. Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
https://doi.org/10.1016/j.healthplace.20...
,88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
.

Evidence show a loss of health associated with areas with worse socioeconomic, demographic and sanitary conditions. However, racial groups living in areas where they are predominant show better health levels than those living in areas where they are minorities55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
, indicating that living among racially similar individuals may favor community support and the social support network66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
,99. Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch S. Residential segregation and Latino, black and white mortality in New York City. J Urban Health 2006; 83(3): 406-20. https://doi.org/10.1007/s11524-006-9035-8
https://doi.org/10.1007/s11524-006-9035-...
,1010. Gibbons J, Yang TC. Self-rated health and residential segregation: How does race/ethnicity matter? J Urban Health 2014; 91(4): 648-60. https://doi.org/10.1007/s11524-013-9863-2
https://doi.org/10.1007/s11524-013-9863-...
.

Racial density is commonly measured from population records of the Demographic Census, where self-reported color/race data are aggregated into the same geographical unit of interest. Next, they are related to socioeconomic, sanitary and health data to explore the ecological relationship between categories or levels of racial density with life and health situations inside neighborhoods, cities, states or countries44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
.

Studies on racial density are mainly conducted in the United States (USA) and the United Kingdom, and report on the association between socioeconomic and sanitary measures of places with health outcomes, including: all-cause and child mortality, health self-assessment, life expectancy, chronic and emotional diseases, and health behaviors44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
. However, the racial categories used and the findings observed cannot be generalized to other national contexts of different racial formative characteristics88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
, methodologies and racial classification systems11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,22. Muniz JO. Preto no branco? Mensuração, relevância e concordância classificatória no país da incerteza racial. Dados 2012; 55(1): 251-82. http://dx.doi.org/10.1590/S0011-52582012000100007
http://dx.doi.org/10.1590/S0011-52582012...
.

Proposals of racial density categories for Brazilian cities have not yet been made, which makes it impossible to know if these groups capture contextual socioeconomic, infrastructure and health inequalities in the country. These questions are important for Brazil, since data from the Demographic Censuses of 2000 and 2010 show that the country is racially diverse and geographically extensive, presenting socio-economic, demographic, sanitary and racial changes among its cities with different population sizes and densities, which have made the country less unfair1111. Instituto Brasileiro de Geografia e Estatística. Censo demográfico e contagem da população: população residente, por cor ou raça, segundo a situação do domicílio, o sexo e a idade. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011 [acessado em 16 set. 2015]. Disponível em: Disponível em: http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
http://www.sidra.ibge.gov.br/bda/tabela/...
,1212. Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
http://atlasbrasil.org.br/2013/download...
,1313. Brasil. Ministério da Saúde. Portal da Saúde. Informações de saúde (Tabnet): estatísticas vitais [Internet]. Brasil: Ministério da Saúde; 2014 [acessado em 10 set. 2015]. Disponível em: Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0205&VObj=http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10
http://www2.datasus.gov.br/DATASUS/index...
,1414. Instituto de Pesquisa Econômica Aplicada. Atlas da vulnerabilidade social [Internet]. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015 [acessado em 3 set. 2015]. Disponível em: Disponível em: http://ivs.ipea.gov.br/ivs/pt/consulta/
http://ivs.ipea.gov.br/ivs/pt/consulta/...
. However, despite these improvements in the redistribution of socioeconomic and health resources, inequalities still persist1212. Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
http://atlasbrasil.org.br/2013/download...
,1515. Victora CG, Barreto ML, Leal MC, Monteiro CA, Schmidt MI, Paim J, et al. Condições de saúde e inovações nas políticas de saúde no Brasil: o caminho a percorrer. Lancet 2011; 377(9782): 2042-53. https://doi.org/10.1016/S0140-6736(11)60055-X
https://doi.org/10.1016/S0140-6736(11)60...
. This reduction did not occur in the same intensity between individuals and places. Therefore, the relations between racial density and socioeconomic and health indicators need to be interpreted in the context of Brazilian cities.

This study identified categories of racial density for Brazilian cities and explored the socioeconomic, demographic and health status in these categories of cities in the years of the 2000 and 2010 Demographic Censuses.

METHOD

This is an exploratory ecological study conducted with secondary data aggregates available online by Brazilian research institutions1111. Instituto Brasileiro de Geografia e Estatística. Censo demográfico e contagem da população: população residente, por cor ou raça, segundo a situação do domicílio, o sexo e a idade. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011 [acessado em 16 set. 2015]. Disponível em: Disponível em: http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
http://www.sidra.ibge.gov.br/bda/tabela/...
,1212. Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
http://atlasbrasil.org.br/2013/download...
,1313. Brasil. Ministério da Saúde. Portal da Saúde. Informações de saúde (Tabnet): estatísticas vitais [Internet]. Brasil: Ministério da Saúde; 2014 [acessado em 10 set. 2015]. Disponível em: Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0205&VObj=http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10
http://www2.datasus.gov.br/DATASUS/index...
,1414. Instituto de Pesquisa Econômica Aplicada. Atlas da vulnerabilidade social [Internet]. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015 [acessado em 3 set. 2015]. Disponível em: Disponível em: http://ivs.ipea.gov.br/ivs/pt/consulta/
http://ivs.ipea.gov.br/ivs/pt/consulta/...
. The units of analysis were the Brazilian cities existing in the years of the Demographic Censuses conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2000 (n = 5,507) and 2010 (n = 5,565).

Using the self-reported color/race information of the population, the racial density was calculated for Brazilian cities in both years of the census. In Brazil, only in census years, color/race information is collected and made available by IBGE1111. Instituto Brasileiro de Geografia e Estatística. Censo demográfico e contagem da população: população residente, por cor ou raça, segundo a situação do domicílio, o sexo e a idade. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011 [acessado em 16 set. 2015]. Disponível em: Disponível em: http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
http://www.sidra.ibge.gov.br/bda/tabela/...
,1616. Instituto Brasileiro de Geografia e Estatística. Sinopse preliminar do censo demográfico 2000. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2000 [acessado em 1º set. 2015]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/sinopse_preliminar/Censo2000sinopse.pdf
http://www.ibge.gov.br/home/estatistica/...
,1717. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características da população e dos domicílios, resultados do universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3º set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
http://www.ibge.gov.br/home/estatistica/...
for each city in the country. In2000, she composed the sample questionnaire (applied to almost 11% of the country’s population) and, in 2010, the basic questionnaire, covering the entire Brazilian population1111. Instituto Brasileiro de Geografia e Estatística. Censo demográfico e contagem da população: população residente, por cor ou raça, segundo a situação do domicílio, o sexo e a idade. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011 [acessado em 16 set. 2015]. Disponível em: Disponível em: http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
http://www.sidra.ibge.gov.br/bda/tabela/...
,1616. Instituto Brasileiro de Geografia e Estatística. Sinopse preliminar do censo demográfico 2000. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2000 [acessado em 1º set. 2015]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/sinopse_preliminar/Censo2000sinopse.pdf
http://www.ibge.gov.br/home/estatistica/...
,1717. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características da população e dos domicílios, resultados do universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3º set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
http://www.ibge.gov.br/home/estatistica/...
.

The proportion of racial density was obtained by dividing the number of residents who were classified as belonging to a racial group in each city by the total population residing in it. The calculation was made separately for White/Caucasian, Brown, Black and for the sum of Yellows with Indian (considered racial minorities) people. From the parameters available in Inagami et al. and Gibbons and Yang, four groups of predominant racial density structure were created: White/Caucasian, Brown, Black and minorities. The categories were obtained when each racial group had a proportion of ≥ 60.0% in the population and proportions of other racial groups, respectively, less than 20.0%. The cities that did not present predominance of one racial group over the others were later stratified into two new groups: mixed races, but mostly White/Caucasian (proportion of white population simply greater than the proportion of black population [Brown plus Black]) and mixed races, but mostly Black (proportion of black population [Brown plus Black] simply higher than the proportion of Whites/Caucasians).

The geographical distribution of Brazilian cities according to the six categories of racial density in 2000 and 2010 was presented in maps. However, in the analysis phase (because of the low frequency), in 2000, a city with a majority of Blacks was not included and two cities with the majority of racial minorities. In 2010, four cities dominated by racial minorities were also not included, and there were no predominantly Black cities.

Thus, only four categories of racial density (Brown, mixed races, but mostly Black, mixed races, but mostly White/Caucasian and White/Caucasian) were used, for which characteristics of interest were described in the years 2000 and 2010. Among the demographic and geographical variables used: male population proportion and age (in years): 0 to 4, 5 to 14, 15 to 24, 25 to 64 and ≥ 65; macro-regions of the country (North, Northeast, Midwest, Southeast and South).

The following socioeconomic measures were presented: median Human Development Index (HDI), Social Vulnerability Index (SVI) and the Gini Index (measures income concentration). These contextual indicators synthesize the levels of well-being, life situation and socioeconomic level of populations and places 1212. Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
http://atlasbrasil.org.br/2013/download...
,1414. Instituto de Pesquisa Econômica Aplicada. Atlas da vulnerabilidade social [Internet]. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015 [acessado em 3 set. 2015]. Disponível em: Disponível em: http://ivs.ipea.gov.br/ivs/pt/consulta/
http://ivs.ipea.gov.br/ivs/pt/consulta/...
,1515. Victora CG, Barreto ML, Leal MC, Monteiro CA, Schmidt MI, Paim J, et al. Condições de saúde e inovações nas políticas de saúde no Brasil: o caminho a percorrer. Lancet 2011; 377(9782): 2042-53. https://doi.org/10.1016/S0140-6736(11)60055-X
https://doi.org/10.1016/S0140-6736(11)60...
,1818. Jannuzzi PM. Indicadores sociais no Brasil. 4ª ed. Campinas: Alínea; 2009., and can assume any value between 0 and 1. SVI and Gini values closer to 1 indicate worse disadvantages, while for the HDI, higher levels of human development. From the cut-off points established in the literature1212. Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
http://atlasbrasil.org.br/2013/download...
,1717. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características da população e dos domicílios, resultados do universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3º set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
http://www.ibge.gov.br/home/estatistica/...
, the proportions of HDI (low, medium and high), Gini (low and extreme) and SVI levels (verylow, low, medium, high and very high) were also presented.

The ratio of racial density to health was measured using the mean global health indicators: Infant Mortality Rate (IMR) (< 1 year of age), Premature Mortality Rate (PMR) (in<65years of age ), adjusted for age, per 100,000 inhabitants, and life expectancy at birth (LEB) (in years). PMR was adjusted for age by the direct method1919. Hinde A. Demographic methods. Nova York: Arnold; 1998., using as reference the Brazilian population of the 2000 and 2010 Censuses.

The research was done with aggregates of secondary data available online, which do not contain confidential information and required approval by the Research Ethics Committee. The study was conducted in accordance with Resolution No. 466 of the National Health Council of December 12, 2012.

RESULTS

In the geographic maps of Brazil, in 2000 and 2010, the racial density categories were distributed associated with the regions of the country. Despite a significant substitution in racial composition within cities and among the regions of the country, the majority of White/Caucasian-dominated cities still occupied the South and Southeast Regions, ethnic minorities remained restricted to the Northern Region; the ones mainly composed of Browns predominated in the Northeast and in the rest of the country predominated cities with a population classified as mixed, though with a Black majority (Figure 1).

Figure 1.
Geographic maps of Brazil, according to the racial density of Brazilian cities in the years of Demographic Census (2000 and 2010).

The cities predominated by mixed races, but of Black majority were predominant in relation to other types of city (42.0% in 2000 and 47.6% in 2010), while those with Browns were the least frequent ones (7.6% in 2000, and 10.2% in 2010). There was a reduction in the presence of cities dominated by Whites/Caucasians and an increase for all other categories in the same period. Cities classified by mixed but with Black majority harbored the largest population volume and those with Browns, the lowest in the two years of census. The proportion of population in cities predominated by whites decreased from 26.9%, in 2000, to 16.6%, in 2010 (Table 1).

Table 1.
Number and proportion of cities and total population in Brazilian cities, according to racial density in 2000 and 2010.

Age structure in the cities changed over the censuses: there was a reduction in the young population (< 24 years) and an increase in the adult (25 to 64 years) and the elderly population (≥ 65 years). The proportion of the latter two groups increased with the predominance of the White/Caucasian population. However, the adult population still remained the majority in both censuses (Table 2).

Table 2.
Relative distribution of demographic and geographic characteristics according to the racial density of Brazilian cities in 2000 and 2010.

The HDI, Gini and SVI levels in all racial densities between 2000 and 2010 were improved. The HDI showed a gradient according to racial density, but cities predominated by Whites/Caucasians had higher levels (0.619, in 2000, and 0.730, in 2010) than the other cities. Citiesdominated by Browns were those with the worst levels (0.403, in 2000, and 0.579, in 2010). Thispattern of evolution and positive gradient according to the racial density between the years was also observed for the Gini and SVI. The Gini showed a more uneven income concentration as the proportion of non-Whites/Caucasians increased. On the other hand, the SVI, although decreasing in all racial densities, remained more vulnerable to populations in cities with a lower proportion of Whites, as there was a decrease in SVI according to the increase of Whites/Caucasians in the racial composition of the cities. In relation to the proportions of these three indicators, there was a substantial reduction in the proportion of cities with a low HDI and an increase in the average level, but most of the cities predominated by Browns or mixed races, but mostly Black, still had a large proportion of low HDI. The condition of extreme income concentration (Gini ≥ 0.5) also declined in the period, but still remained more prevalent in cities predominated by non-Whites/Caucasians, reaching, in 2010, values above 85% in cities with a majority of Browns against 25.5% in which White/Caucasian people prevail. The proportion of mean SVI became predominant in all racial densities between 2000 and 2010, but the proportion of low SVI was still small in all cities (Table 3).

Table 3.
Distribution of socioeconomic characteristics and global health indicators according to the racial density of Brazilian cities in 2000 and 2010.

The analysis of global health indicators showed that, between 2000 and 2010, cities predominated by Browns had a greater reduction in IMR and an increase in LEB, while cities with a majority of Whites/Caucasians were the only ones that had a reduction in PMR. However, the measures of these indicators worsened with the reduction of the White/Caucasian population, with the cities predominated by Browns those with the highest PMR in 2010 (261.2/100 thousand inhabitants). Similar LEB levels observed in 2000 in mixed density cities, but with a majority of White/Caucasian (70.0), and White/Caucasian (72.0), were only reached in cities with Brown (70.7) and mixed races density, but mostly Black (71.9) 10years later, in 2010 (Table 3).

DISCUSSION

This research proposed the classification of racial density for Brazilian cities in the years of Census (2000 and 2010), through which an important pattern of racial distribution within these cities was observed. There were four main categories, which express a continuum of racial concentration between them, ranging from cities dominated by Browns, followed by mixed races, but mostly Black, and mixed races, but mostly White/Caucasian, to those predominantly White/Caucasian. The contemporary presence and spatial distribution of these categories indicated that the racial formation of Brazilian cities reflects historical trends of colonization, inheritances of the slave industry, settlement policies, residential lease choices, land connections, fertility patterns, influence of racial classification, migration and immigration occurred between and within the great regions of the country 2020. Marx A. Making race and nation: a comparison of south Africa, the United States and Brazil. Cambridge: Cambridge University Press; 1998.,2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.. The cities predominated by mixed races, but mostly Black, were predominant in the two years of census as well as they harbored the largest volume of population in the same period. The absolute and relative reduction of cities and the White/Caucasian population in White/Caucasian density cities, as well as their increase in other types of municipalities suggest that the racial composition of the growing Brazilian population presented itself dynamically and, similarly to other countries, Brazil has increasingly become more racially heterogeneous55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,2222. Chiavegatto Filho ADP, Beltrán-Sánchez H, Kawachi I. Racial disparities in life expectancy in Brazil: challenges from a multiracial society. Am J Public Health 2014; 104(11): 2156-62. https://doi.org/10.2105/AJPH.2013.301565
https://doi.org/10.2105/AJPH.2013.301565...
,2323. Stafford M, Becares L, Nazroo J. Objective and perceived ethnic density and health: findings from a United Kingdom general population survey. Am J Epidemiol 2009; 170(4): 484-93. https://doi.org/10.1093/aje/kwp160
https://doi.org/10.1093/aje/kwp160...
, though this reduction observed may be more related to changes in social relations in Brazil at the beginning of this century than to factors that changed the demographic structure of thepopulation. It is possible that the greater debate in Brazil about affirmative policies, access to its benefits and the fluidity of racial classification have influenced racial perception and its change over time in the country.

The results pointed out that the proposal of categories of racial density, as observed in other countries33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
,77. Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
https://doi.org/10.1016/j.healthplace.20...
,88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
,2424. Bécares L, Nazroo J, Jackson J, Heuvelman H. Ethnic density effect on health and experienced racism among Caribbean people in the US and England: a cross-national comparison. Soc Sci Med 2012; 75(12): 2107-15. https://doi.org/10.1016/j.socscimed.2012.03.046
https://doi.org/10.1016/j.socscimed.2012...
, reflected aggregates of socioeconomic, demographic and social infrastructure attributes of the places, which are related to the pattern of spatial distribution of living conditions, health and well-being of the various racial groups within these spaces. In general, racial density categories captured inequalities and pointed to the persistence of worse material conditions of life, health and quality of life in the cities predominated by Browns and mixed races, but mostly Black, and better ones where predominantly White/Caucasian. There was a significant time lag in the cities predominated by Browns and mixed races, but mostly Black, in relation to the others, as they presented younger age structure, worse HDI, SVI and Gini estimates, higher IMR and PMR estimates, and smaller LEB of its residents.

The general conditions of life and health of Blacks in Brazil have always been worse than those of the White/Caucasian population2020. Marx A. Making race and nation: a comparison of south Africa, the United States and Brazil. Cambridge: Cambridge University Press; 1998.,2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.,2222. Chiavegatto Filho ADP, Beltrán-Sánchez H, Kawachi I. Racial disparities in life expectancy in Brazil: challenges from a multiracial society. Am J Public Health 2014; 104(11): 2156-62. https://doi.org/10.2105/AJPH.2013.301565
https://doi.org/10.2105/AJPH.2013.301565...
. Browns and Blacks, since the enslavement period, were subjected to a greater burden of tropical diseases and illnesses, high infant and maternal mortality, low life expectancy, precarious sanitary and social infrastructure in the places where they lived, as well as lack of access to goods and social services, such as schools, formal labor and access to health, even after the abolition of slavery in 18882020. Marx A. Making race and nation: a comparison of south Africa, the United States and Brazil. Cambridge: Cambridge University Press; 1998.,2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.. This socioeconomic exclusion, abandonment, disinvestment and racial discrimination have occurred throughout life and generations and, successively, exposed these groups to a number of disadvantages that are still observed in social and health indicators2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.,2222. Chiavegatto Filho ADP, Beltrán-Sánchez H, Kawachi I. Racial disparities in life expectancy in Brazil: challenges from a multiracial society. Am J Public Health 2014; 104(11): 2156-62. https://doi.org/10.2105/AJPH.2013.301565
https://doi.org/10.2105/AJPH.2013.301565...
.

In some countries, there are proposals for ethnic-racial density categories for their respective populations. In general, the strata reflect the conceptions and concepts about race and ethnicity, the methodologies of racial classification in each country and the main racial groups present in these spaces, which national surveys or censuses can capture11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,22. Muniz JO. Preto no branco? Mensuração, relevância e concordância classificatória no país da incerteza racial. Dados 2012; 55(1): 251-82. http://dx.doi.org/10.1590/S0011-52582012000100007
http://dx.doi.org/10.1590/S0011-52582012...
. In the United States, the most used categories are Whites/Caucasians, non-Whites/Caucasians, Blacks and Latinos99. Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch S. Residential segregation and Latino, black and white mortality in New York City. J Urban Health 2006; 83(3): 406-20. https://doi.org/10.1007/s11524-006-9035-8
https://doi.org/10.1007/s11524-006-9035-...
, or there may also be a comparison between Hispanics, non-Hispanic Blacks and non-Hispanic Whites55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,1010. Gibbons J, Yang TC. Self-rated health and residential segregation: How does race/ethnicity matter? J Urban Health 2014; 91(4): 648-60. https://doi.org/10.1007/s11524-013-9863-2
https://doi.org/10.1007/s11524-013-9863-...
or an interest only in different groups of Latinos (Cubans, Puerto Ricans and Mexicans)77. Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
https://doi.org/10.1016/j.healthplace.20...
. In Canada, the focus is on non-White/Caucasian groups such as Blacks, people from the Far East (Chinese, Koreans and Japanese), Filipinos, Arabs, people from West Asia and Latin Americans55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
. In the United Kingdom, comparisons can occur among African Blacks, Caribbean Blacks, Indians, Pakistanis and Bengalese33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
; other studies also include British and Irish Whites/Caucasians2525. Das-Munshi J, Becares L, Dewey ME, Stansfeld SA, Price M. Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England. BMJ 2010; 341: c5367. https://doi.org/10.1136/bmj.c5367
https://doi.org/10.1136/bmj.c5367...
or Whites/Caucasians, Caribbeans, Indian and groups of Pakistanis with Bengalese2626. Karlsen S, Nazroo JY, Stephenson R. Ethnicity, environment and heath: putting ethnic inequalities in health in their place. Soc Sci Med 2002; 55(9): 1647-61., with less interest in the category of people from the Far East55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
. In Estonia2727. Leetmaa K, Tammaru T, Hess DB. Preferences toward neighbor ethnicity and affluence: evidence from an inherited dual ethnic context in post-Soviet Tartu, Estonia. Ann Assoc Am Geogr 2005; 105(1): 162-82. https://doi.org/10.1080/00045608.2014.962973
https://doi.org/10.1080/00045608.2014.96...
and New Zealand88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
the interest is in comparing ethnic minorities to the rest of the population.

Regarding the relationship between racial density and health, Bécares et al.55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
identified among the 57 articles included in the systematic review, that the majority of the analyses focused on Blacks (n = 42) and Hispanic Americans (n ​​= 15) and the smallest part of them, in ethnic minorities in the United Kingdom (n = 6) and other populations (n ​​= 5), suggesting particular interest in this subject in a few racial groups that reside mainly in the United States and the United Kingdom. It was observed that the measurement of racial density in both countries varies substantially, reflecting differences in the percentage levels to form categories of racial density33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
. In comparison, our study used the racial categories of the country used by IBGE (Whites/Caucasians, Browns and Blacks, Yellows, Indigenous) and collected individually to define categories of racial density for Brazilian cities. Although there are variations among categories, percentages and methods used to measure racial density between studies, this research also managed to capture wide inequalities between cities and their populations, pointing out in temporal and ecological perspective the relation between racial density and precarious socioeconomic conditions, social exclusion and worse health 33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,88. Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
https://dx.doi.org/10.1016%2Fj.socscimed...
,1010. Gibbons J, Yang TC. Self-rated health and residential segregation: How does race/ethnicity matter? J Urban Health 2014; 91(4): 648-60. https://doi.org/10.1007/s11524-013-9863-2
https://doi.org/10.1007/s11524-013-9863-...
,2424. Bécares L, Nazroo J, Jackson J, Heuvelman H. Ethnic density effect on health and experienced racism among Caribbean people in the US and England: a cross-national comparison. Soc Sci Med 2012; 75(12): 2107-15. https://doi.org/10.1016/j.socscimed.2012.03.046
https://doi.org/10.1016/j.socscimed.2012...
.

Among the studies evaluating the influence of racial density on health, discrepancies between its results can also be attributed to differences in cut-offs that define racial density, in the racial or ethnic groups used, in analytical approaches, geographical units, sample sizes, covariates considered in adjustment, variations among countries, cultural contexts, racial classification methods, and health measures examined11. Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
http://dx.doi.org/10.1590/S0103-73312012...
,44. Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
https://doi.org/10.1016/j.healthplace.20...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
,66. Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
https://doi.org/10.1016/j.healthplace.20...
,77. Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
https://doi.org/10.1016/j.healthplace.20...
. Researches conducted in the USA, compared to the UK, have been more successful in their analyses. Consideringmortality indicators, there was an association between racial density among Blacks in the USA, but this effect depended, in some cases, on the age and gender of the death55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
, as it was observed that mortality in the first years of life was more sensitive to the precariousness of socioeconomic indicators33. Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
https://doi.org/10.1016/j.socscimed.2009...
,55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
, while among the elderly (≥ 65 years) it was related to diseases and chronic-degenerative diseases more related to health behaviors55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
. For other ethnic groups (inside and outside the United States), racial density presented a detrimental effect, but in some cases presented null associations55. Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
https://doi.org/10.2105/AJPH.2012.300832...
, which suggests that the effects of racial density on health are still complex.

Despite the results, reservations should be made about them. Ecological studies may have biased results, since the relationships observed in aggregate form do not necessarily reproduce in the same way individually. However, the considerable number of cities in each category makes it possible to identify marked inequalities that have persisted over the years. Regarding the color/race variable, it is possible that the differences observed are due to changes in the mode of collection of the variable in the period, since, in 2000, the totals observed represent an expansion of the collected sample and, in 2010, the total for the entire population of the country1616. Instituto Brasileiro de Geografia e Estatística. Sinopse preliminar do censo demográfico 2000. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2000 [acessado em 1º set. 2015]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/sinopse_preliminar/Censo2000sinopse.pdf
http://www.ibge.gov.br/home/estatistica/...
,1717. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características da população e dos domicílios, resultados do universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3º set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
http://www.ibge.gov.br/home/estatistica/...
. The official Brazilian racial classification scheme diverges from the popular system or even from the one created by demands of the social movements in the country2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.,2828. Morning A. The nature of race: how scientists think and teach about human difference. Califórnia: University of California Press; 2011.. This may lead individuals to arbitrarily classify themselves into racial categories different from those they would like to classify. Therefore, it is possible that racial classification is not fixed, that individuals do not definitively belong to racial groups over time and that racial categories do not form such homogeneous groups. Anotherissue is that racial classification in Brazil occurs through a fluid and dynamic race/color line, creating an intermediate, inaccurate, and subjective zone that can lead the “Brown” racial category to lose people to the “White/Caucasian” category or receive many “Blacks”. Finally, racial classification is contextual and can change over time and according to different places. Itsuffers from the influence of psychosocial, geographic, economic, political and cultural factors existing in each society2121. Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.,2828. Morning A. The nature of race: how scientists think and teach about human difference. Califórnia: University of California Press; 2011.,2929. Instituto Brasileiro de Geografia e Estatística. Coordenação de População e Indicadores Sociais. Características étnico-raciais da população: um estudo das categorias de classificação de cor ou raça: 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3 set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/caracteristicas_raciais/PCERP2008.pdf
http://www.ibge.gov.br/home/estatistica/...
. However, despite these issues, the official Brazilian racial classification system in five categories allows greater comparability with other national studies and over time, in addition to using the most frequent racial categories in the country2929. Instituto Brasileiro de Geografia e Estatística. Coordenação de População e Indicadores Sociais. Características étnico-raciais da população: um estudo das categorias de classificação de cor ou raça: 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3 set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/caracteristicas_raciais/PCERP2008.pdf
http://www.ibge.gov.br/home/estatistica/...
. Thus,although the pattern of racial composition in the country presents itself in a dynamic way, the racial inequalities that arise between these categories still persist throughout the years 2000.

CONCLUSION

This study presented categories of racial density for Brazilian cities and described in an exploratory way the inequalities in the situation of the general conditions of life and health among them in the early 2000s, pointing out that these categories are proxies of deprivation and deterioration of the conditions of life and health that occur within cities. Futureanalyzes of racial inequalities in the country from these city aggregates can offer important contributions to the field of social epidemiology and racial relations in Brazil.

REFERÊNCIAS

  • 1
    Kabad JF, Bastos JL, Santos RV. Raça, cor e etnia em estudos epidemiológicos sobre populações brasileiras: revisão sistemática na base PubMed. Physes 2012; 22(3): 895-918. http://dx.doi.org/10.1590/S0103-73312012000300004
    » http://dx.doi.org/10.1590/S0103-73312012000300004
  • 2
    Muniz JO. Preto no branco? Mensuração, relevância e concordância classificatória no país da incerteza racial. Dados 2012; 55(1): 251-82. http://dx.doi.org/10.1590/S0011-52582012000100007
    » http://dx.doi.org/10.1590/S0011-52582012000100007
  • 3
    Pickett KE, Shaw RJ, Atkin K, Kiernan KE, Wilkinson RG. Ethnic density effect on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69(10): 1476-83. https://doi.org/10.1016/j.socscimed.2009.08.031
    » https://doi.org/10.1016/j.socscimed.2009.08.031
  • 4
    Bécares L, Nazroo J, Stafford M. The buffering effects of ethnic density on experienced racism and heath. Health Place 2009; 15(3): 670-8. https://doi.org/10.1016/j.healthplace.2008.10.008
    » https://doi.org/10.1016/j.healthplace.2008.10.008
  • 5
    Bécares L, Shaw R, Nazroo J, Stafford M, Albor C, Atkin K, et al. Ethnic density effect on physical morbidity, mortality, and health behaviors; a systematic review of the literature. Am J Public Health 2012; 102(12): e33-66. https://doi.org/10.2105/AJPH.2012.300832
    » https://doi.org/10.2105/AJPH.2012.300832
  • 6
    Bécares L, Das-Munshi J. Ethnic density, health care seeking behavior and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22: 48-55. https://doi.org/10.1016/j.healthplace.2013.03.005
    » https://doi.org/10.1016/j.healthplace.2013.03.005
  • 7
    Bécares L. Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health Place 2014; 30: 177-86. https://doi.org/10.1016/j.healthplace.2014.09.010
    » https://doi.org/10.1016/j.healthplace.2014.09.010
  • 8
    Bécares L, Cormack D, Harris R. Ethnic density effect and area deprivation: neighborhoods effects on Mãori health and discrimination in Aotearoa/New Zealand. Soc Sci Med 2013; 88: 76-82. https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
    » https://dx.doi.org/10.1016%2Fj.socscimed.2013.04.007
  • 9
    Inagami S, Borrell LN, Wong MD, Fang J, Shapiro MF, Asch S. Residential segregation and Latino, black and white mortality in New York City. J Urban Health 2006; 83(3): 406-20. https://doi.org/10.1007/s11524-006-9035-8
    » https://doi.org/10.1007/s11524-006-9035-8
  • 10
    Gibbons J, Yang TC. Self-rated health and residential segregation: How does race/ethnicity matter? J Urban Health 2014; 91(4): 648-60. https://doi.org/10.1007/s11524-013-9863-2
    » https://doi.org/10.1007/s11524-013-9863-2
  • 11
    Instituto Brasileiro de Geografia e Estatística. Censo demográfico e contagem da população: população residente, por cor ou raça, segundo a situação do domicílio, o sexo e a idade. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2011 [acessado em 16 set. 2015]. Disponível em: Disponível em: http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
    » http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?c=3175&z=cd&o=7
  • 12
    Programa das Nações Unidas para o Desenvolvimento. Atlas de desenvolvimento humano: índice de desenvolvimento humano no Brasil 2013 [Internet]. Programa das Nações Unidas para o Desenvolvimento; 2013 [acessado em 15 dez. 2013]. Disponível em: Disponível em: http://atlasbrasil.org.br/2013/download
    » http://atlasbrasil.org.br/2013/download
  • 13
    Brasil. Ministério da Saúde. Portal da Saúde. Informações de saúde (Tabnet): estatísticas vitais [Internet]. Brasil: Ministério da Saúde; 2014 [acessado em 10 set. 2015]. Disponível em: Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0205&VObj=http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10
    » http://www2.datasus.gov.br/DATASUS/index.php?area=0205&VObj=http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10
  • 14
    Instituto de Pesquisa Econômica Aplicada. Atlas da vulnerabilidade social [Internet]. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015 [acessado em 3 set. 2015]. Disponível em: Disponível em: http://ivs.ipea.gov.br/ivs/pt/consulta/
    » http://ivs.ipea.gov.br/ivs/pt/consulta/
  • 15
    Victora CG, Barreto ML, Leal MC, Monteiro CA, Schmidt MI, Paim J, et al. Condições de saúde e inovações nas políticas de saúde no Brasil: o caminho a percorrer. Lancet 2011; 377(9782): 2042-53. https://doi.org/10.1016/S0140-6736(11)60055-X
    » https://doi.org/10.1016/S0140-6736(11)60055-X
  • 16
    Instituto Brasileiro de Geografia e Estatística. Sinopse preliminar do censo demográfico 2000. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2000 [acessado em 1º set. 2015]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/sinopse_preliminar/Censo2000sinopse.pdf
    » http://www.ibge.gov.br/home/estatistica/populacao/sinopse_preliminar/Censo2000sinopse.pdf
  • 17
    Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010: características da população e dos domicílios, resultados do universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3º set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
    » http://www.ibge.gov.br/home/estatistica/populacao/censo2010/caracteristicas_da_populacao/resultados_do_universo.pdf
  • 18
    Jannuzzi PM. Indicadores sociais no Brasil. 4ª ed. Campinas: Alínea; 2009.
  • 19
    Hinde A. Demographic methods. Nova York: Arnold; 1998.
  • 20
    Marx A. Making race and nation: a comparison of south Africa, the United States and Brazil. Cambridge: Cambridge University Press; 1998.
  • 21
    Telles EE. O significado da raça na sociedade brasileira. Princeton e Oxford: Princeton University Press; 2004.
  • 22
    Chiavegatto Filho ADP, Beltrán-Sánchez H, Kawachi I. Racial disparities in life expectancy in Brazil: challenges from a multiracial society. Am J Public Health 2014; 104(11): 2156-62. https://doi.org/10.2105/AJPH.2013.301565
    » https://doi.org/10.2105/AJPH.2013.301565
  • 23
    Stafford M, Becares L, Nazroo J. Objective and perceived ethnic density and health: findings from a United Kingdom general population survey. Am J Epidemiol 2009; 170(4): 484-93. https://doi.org/10.1093/aje/kwp160
    » https://doi.org/10.1093/aje/kwp160
  • 24
    Bécares L, Nazroo J, Jackson J, Heuvelman H. Ethnic density effect on health and experienced racism among Caribbean people in the US and England: a cross-national comparison. Soc Sci Med 2012; 75(12): 2107-15. https://doi.org/10.1016/j.socscimed.2012.03.046
    » https://doi.org/10.1016/j.socscimed.2012.03.046
  • 25
    Das-Munshi J, Becares L, Dewey ME, Stansfeld SA, Price M. Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England. BMJ 2010; 341: c5367. https://doi.org/10.1136/bmj.c5367
    » https://doi.org/10.1136/bmj.c5367
  • 26
    Karlsen S, Nazroo JY, Stephenson R. Ethnicity, environment and heath: putting ethnic inequalities in health in their place. Soc Sci Med 2002; 55(9): 1647-61.
  • 27
    Leetmaa K, Tammaru T, Hess DB. Preferences toward neighbor ethnicity and affluence: evidence from an inherited dual ethnic context in post-Soviet Tartu, Estonia. Ann Assoc Am Geogr 2005; 105(1): 162-82. https://doi.org/10.1080/00045608.2014.962973
    » https://doi.org/10.1080/00045608.2014.962973
  • 28
    Morning A. The nature of race: how scientists think and teach about human difference. Califórnia: University of California Press; 2011.
  • 29
    Instituto Brasileiro de Geografia e Estatística. Coordenação de População e Indicadores Sociais. Características étnico-raciais da população: um estudo das categorias de classificação de cor ou raça: 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística ; 2011 [acessado em 3 set. 2012]. Disponível em: Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/caracteristicas_raciais/PCERP2008.pdf
    » http://www.ibge.gov.br/home/estatistica/populacao/caracteristicas_raciais/PCERP2008.pdf
  • Financial support: Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) (project number: E-26/100.357/2013).

Publication Dates

  • Publication in this collection
    25 Apr 2019
  • Date of issue
    2019

History

  • Received
    05 July 2017
  • Reviewed
    11 Aug 2017
  • Accepted
    01 Sept 2017
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