Evaluation of the adequacy of care for individuals with diabetes in Brazil: The intersection between gender, race, and socioeconomic profile

Introduction: Diabetes is a major global public health problem. Inequity in access to healthcare services represents a significant challenge for healthcare management and particularly affects vulnerable populations, understanding the intersectionality of these social determinants of health is essential. Objective: To evaluate the adequacy of care provided to individuals with diabetes in Brazil, considering the intersection of gender, race, and socioeconomic profile. Methods: This study was based on data from the Brazilian National Health Survey (2019–2020). 6,967 individuals self-reported a diagnosis of diabetes and composed the study sample. The “adequacy of care” outcome variable was analyzed according to sociodemographic characteristics. The intersection of gender, race and socioeconomic profile was considered according to the intersectionality theory. Descriptive and multivariate analyses were conducted using Poisson regression (prevalence ratio [PR]) with robust variance and corresponding 95% confidence intervals (95%CI). Results: Black women with low income was the predominant profile of people with diabetes (22.0%; 95%CI: 20.5 to 23.3). Prevalent gaps in care delivery encompassed a lack of care for diabetic foot and failure to refer patients to a specialist doctor. The highest prevalence of low adequacy of care was observed in black men (79.6%; 95%CI: 75.7 to 83.1) and women (79.1%; 95%CI: 76.2 to 81.8) with low income. In the multivariate model, low adequacy of care was associated with black women and men with low income (PR = 1.09 [95%CI: 1.00 to 1.20] and 1.10 [95%CI: 1.00 to 1.21]), absence of diabetes-related complications (PR = 1.18 [95%CI: 1.11 to 1.25]), and no history of diabetes-related hospitalization (PR = 1.12 [95%CI: 1.03 to 1.22]). Conclusion: Baseline challenges of living with diabetes in Brazil are further exacerbated for socially vulnerable groups. Our findings highlight structural racism and poverty as critical social determinants of health. Adopting an intersectionality approach enables a more nuanced understanding of health inequities.