The interplay of contextual layers: A multilevel analysis of income distribution, neighborhood infrastructure, socioeconomic position and self-rated health in Brazil

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Our hypothesis is that neighborhood infrastructure modifies the association between state-level income distribution and self-rated health. In our findings neighborhood infrastructure amplifies the association between income equality and self-rated health, yet with a differential impact on health according to sex, race and education level favoring individuals at higher socioeconomic positions. Most of the individual health variation attributed to context happens at neighborhood level, based on random effects analyses. Our findings contribute to a further understanding of health inequalities in Brazil. The demonstrated synergism between state, neighborhood and individual level determinants of health supports inter-sectoral policies and interventions in a clearly multileveled way.HighlightsNeighborhood infrastructure amplifies the effects of income distribution on health.Synergism between health determinants at state, neighborhood and individual-level.Synergetic effects on health favor individuals in higher socioeconomic positions.Most of the remaining health variance can be attributed to the neighborhood-level.

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