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

Abstract Introduction Existing quantitative studies of violence victimization in Brazil often examine individual demographic and socioeconomic risk factors, limiting insight into how identities can intersect to co-produce vulnerability or resilience. This study uses a nationally representative household survey to investigate how demographic, socioeconomic, and geographic factors intersect to shape the probability of experiencing psychological, physical, and sexual violence among Brazilian adults. Methods Data from the 2019 Brazil National Health Survey was used to created indicators of 12-month experience of three types of interpersonal violence (psychological, physical, and sexual), a measure of any violence and one indicating 2 or more types. Previous literature guided the development of 356 clusters of intersectional identities based on demographic, socioeconomic and other factors. Analyses used the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach based on multilevel analyses of all 356 intersectional strata in addition to individual-level factors. Results Among Brazilian adults, 18.3% (totaling 27,535,272) reported experiencing interpersonal violence and 3.7% experienced more than one type in the past 12 months. Psychological violence (17.4%) was most frequently reported, followed by physical (4.6%) and sexual (0.8%) violence. MAIHDA models revealed that prevalence and risk varied widely across intersectional strata, but that younger age (< 30), being single, living in an urban area, and living with a long-term illness or disability were consistently found in the strata with highest predicted probability of victimization across all types of violence. Being female, being Black, having a college-level education, and being in the lowest wealth tertile were also commonly found in the highest ranked strata across forms of violence victimization. The overall variance attributable to intersectional (as opposed to individual) effects was between 9.3% and 13.0% across different forms of violence, suggesting that risk of experiencing (or reporting) interpersonal violence in this study accumulates largely in additive rather than multiplicative ways. Conclusions This study found that experiences of psychological, physical, and sexual interpersonal violence were patterned by intersecting social and economic inequalities, with higher risk among women, younger adults, Black or Brown individuals, those who are single, urban residents, and people living with long-term health problems. MAIHDA analyses revealed that risk accumulated across overlapping social positions—particularly among young, single, urban Black women with chronic conditions—highlighting the need for violence prevention strategies that address structural drivers of gender, racial, and socioeconomic inequality. Clinical trial number Not applicable.