Intersectionality in the mortality of Brazilians aged 50 years or older: analysis of ELSI-Brasil.

The objective was to analyze the factors associated with all-cause mortality and cause-specific mortality groups, including garbage codes (GC), from an intersectional perspective (operationalized by the combination of sex, race/skin color, education, and income), in a cohort of Brazilians aged 50 years or older. This is a prospective cohort study with data from 8,918 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), followed between 2015 and 2021. Intersectionality was operationalized in 32 strata. Mortality heterogeneity was quantified by the Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). The association with time until death was analyzed using traditional and frailty Cox proportional hazards models, adjusted for sociodemographic, health, and behavioral variables. There were 817 deaths. The MAIHDA model without adjustment variables indicated that 7% of the mortality variation was attributable to differences between intersectional strata. In the final model adjusted with frailty, the adjustment variables explained part of the risk, but the residual analysis showed that strata composed of women with low education maintained a high residual mortality risk. In contrast, high-income non-white men presented a lower risk than expected. Intersectionality is a structural determinant of mortality. The intersection of axes of oppression generates risks that are not reducible to the sum of their parts, demanding policies that act on the social structures that produce inequity.