This study examined the adequacy of a health vulnerability index (HVI) for identifying intra- urban differences in vulnerability in the elderly population. Study participants (n = 1,055) were selected by probabilistic sampling of residents in the city of Belo Horizonte, Minas Gerais State, Brazil, aged 60 years or older (mean = 70.1 years). The HVI was constructed with indicators of socioeconomic conditions and premature mortality at the census tract level. Based on its location and HVI value, each participant’s household was classified as low, medium, or high-risk. Results of multivariate ordinal logistic regression models showed graded and statistically significant associations between the household’s risk level and the social and physical environment, health conditions and behaviors, and health service needs (adjusted prevalence ratios ranging from 1.17; 95%CI: 1.02-1.34 to 1.65; 95%CI: 1.45-1.88). The HVI appears to be a useful instrument for identifying health and social service needs among the elderly.