Intersecting regional, racial, and gender inequalities in metabolic disease mortality in Brazil

This study examines how race, gender, and region intersect to shape mortality from endocrine, nutritional, and metabolic diseases in Brazil. It compares the COVID-19 pandemic period (2020-2023) with the pre-pandemic period (2014-2019) to assess whether structural vulnerabilities persisted during that crisis.

Nationwide ecological time-series using DATASUS from 2014 to 2024. We analysed national mortality data from the Brazilian Mortality Information System (SIM/DATASUS) for 2014-2024, comprising approximately 935,000 deaths, using negative binomial regression models with a population offset and interaction terms.

Regional inequalities remained marked: compared with the Southeast, mortality was 37% higher in the South and 10% higher in the Northeast, whereas the North and Central-west showed 17% and 11% lower mortality, respectively. Before the pandemic, women had slightly lower overall mortality. The intersectional analysis revealed marked vulnerabilities among Black and Brown women in the South, whose incidence rate ratios were as high as 9.6 before the pandemic, declining to 6.5 in the full-period analysis and 3.1 during the pandemic.

These findings suggest that race, gender, and region do not operate in a straightforwardly additive way, but instead intersect to produce specific, historically contingent forms of vulnerability. An intersectional understanding of these patterns may help inform future research and policy on the social production of metabolic health inequalities.