Racial inequality in access to cancer care in Brazil: an intersectional analysis with data from SIM-SUS (2011-2023)

Abstract

The concept of intersectionality describes how complex processes create and perpetuate health inequities. Social and economic inequalities create barriers to cancer care, directly affecting treatment outcomes. This study analyzes racial disparities between Black and White individuals in access to oncological care using a nonlinear statistical decomposition and microdata from the Mortality Information System (SIM-SUS, in Portuguese acronymous) from 2011 to 2023. The results show a 5.9 percentage point gap in access to medical assistance, with larger disparities observed in breast cancer (7.2 p. p.), skin cancer (7.1 p. p.), hematologic malignancies (6.5 p. p.), tumors of the digestive organs (6.3 p. p.), and female genital organs (6.3 p. p.). The decomposition reveals that 83.8% of the racial gap is due to differences in effects—unexplained by observable characteristics—indicating structural inequality. Black populations face higher premature cancer mortality rates, are concentrated in regions with limited healthcare services, and experience lower returns on education and employment. These findings emphasize the need for public policies that ensure equitable access to cancer care and address racial and socioeconomic disparities in health outcomes.