Temporal trends in inequalities of accumulated behavioral risk factors in Brazilian state capitals, 2008-2018

The aim of this study was to assess trends in inequalities regarding sex and edu-cational levels in accumulated behavioral risk factors in the Brazilian state capitals. Repeated surveys from a Vigitel surveillance initiative car-ried out from 2008 to 2018 including adults (>_ 18 years) living in the 26 Brazilian state capitals and in the Federal District were analyzed (n = 569246). Accumulation of at least two behav-ioral risk factors including physical inactivity, inadequate diet, tobacco use and abusive alcohol consumption. Simple and complex measures of inequality were calculated according to sex and educational level, in addition to assessing inter-sectionality between age groups and regions of the country. The accumulated risk factor prevalence between 2008 and 2018 decreased from 51.6% to 41.2% among males and from 45.3% to 30.8% among females. Despite the observed decreasing trends in the prevalence of accumulated risk fac-tors over time, inequalities of sex and educational levels persisted. Adult males and people with low-er levels of education persistently presented higher prevalence of accumulated risk factors, highlight-ing not only the need for monitoring strategies of such inequalities, but also for actions aiming at reducing this trend.