Intersecting inequalities in experiences of violence among Brazilian adults: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) of the 2019 National Health Survey

Hammett, Wilson H.; Macinko, James · 2026 · DOAJ

DOI: 10.1186/s12939-026-02818-x

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Summary

This study investigates how intersecting demographic, socioeconomic, and geographic factors shape the probability of experiencing interpersonal violence among Brazilian adults. Motivated by the limitation of existing research that examines risk factors in isolation, the authors aim to quantify how overlapping identities co-produce vulnerability or resilience. The study applies an intersectional framework to understand structural inequalities as fundamental causes of violence, moving beyond additive models to assess multiplicative effects of marginalized identities. The researchers utilized data from the 2019 Brazil National Health Survey, a nationally representative household survey of 83,942 adults. They created binary indicators for 12-month experiences of psychological, physical, and sexual violence, as well as composite measures for any violence and multiple types of violence. Using the Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach, the study analyzed 356 intersectional strata derived from variables including age, sex, race, relationship status, education, household assets, urbanicity, and long-term illness or disability. This method allowed for the decomposition of variance attributable to intersectional effects versus individual-level factors. Results indicated that 18.3% of Brazilian adults reported experiencing interpersonal violence in the past year, with psychological violence being the most prevalent (17.4%), followed by physical (4.6%) and sexual (0.8%) violence. MAIHDA models revealed substantial variation in predicted probabilities across intersectional strata. Consistently, younger age (<30), being single, living in urban areas, and having a long-term illness or disability were associated with the highest risk across all violence types. Being female, Black, having a college-level education, and residing in the lowest wealth tertile also frequently appeared in high-risk strata. The highest predicted probability for any violence (44.05%) was observed among young, single, Black women with college degrees, low assets, urban residence, and chronic conditions. However, the variance attributable to intersectional effects ranged from 9.3% to 13.0%, suggesting that risk accumulates largely in additive rather than multiplicative ways. The study concludes that experiences of interpersonal violence in Brazil are patterned by intersecting social and economic inequalities. The findings highlight that structural drivers of gender, racial, and socioeconomic inequality significantly shape victimization risks, particularly for young, single, urban Black women with chronic conditions. The authors argue that violence prevention strategies must address these underlying structural inequities rather than focusing solely on individual perpetrators. The use of MAIHDA provided empirical evidence on multidimensional social determinants, reinforcing the need for interventions tailored to the most vulnerable intersections of risk factors.

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• demographic disparities