Amenable Mortality and Neighborhood Inequality: An Ecological Study of São Paulo

This article uses an ecological study design to explore intraurban health inequality in São Paulo by examining neighborhood-level changes in mortality amenable to medical care. We use 2003–2013 data for 95 city districts of São Paulo and apply a random coefficient growth curve modeling approach. We find that improved access to health-care services is associated with reduced amenable mortality. Despite these overall improvements, the magnitude of population health disparities, as measured by amenable mortality, did not diminish. The effects of social, economic, and health system factors on amenable mortality depend on the income level of the district. Persistent disparities in amenable mortality within São Paulo suggests that neighborhood-level differences in social determinants of health and access to health services require further investment from the Brazilian government.