Low-income Black adults with diabetes in Brazil face the highest rates of inadequate disease management in the country, according to a study published in August in the scientific journal PLOS One. Researchers from the Federal University of Rio Grande do Norte (UFRN) analyzed data from the 2019 National Health Survey to uncover stark disparities in chronic disease care across racial and socioeconomic lines.
Disparities in Diabetes Care Across Brazil
The study evaluated 6,967 participants aged 18 and older who reported a medical diagnosis of diabetes. Researchers assessed 15 survey questions covering fundamental aspects of chronic disease management, including dietary guidelines, weight control, physical activity, smoking cessation, laboratory tests such as glycated hemoglobin and cholesterol, specialist referrals, and routine eye and foot examinations. Each positive response added one point to a participant’s care score.
Investigators classified care adequacy as low for individuals who accumulated 12 out of 15 possible points or fewer. Across the entire cohort, 72% of participants scored 12 points or less. When researchers cross-referenced the data by sex, race, and income, low-income Black men and women exhibited the highest prevalences of inadequate care at 79.6% and 79.1%, respectively.
“It’s a very high value, which raises an alert mainly for the Unified Health System, because the majority of these people who participated in our research are totally dependent on the SUS. Very few people have private health insurance,” said Isabelle Ribeiro Barbosa, a professor in the postgraduate program in collective health at UFRN and one of the study’s authors.
Socioeconomic Barriers and the Unified Health System
Low-income individuals frequently encounter obstacles regarding access to the resources and information necessary to manage diabetes effectively. Barbosa attributes this scenario to overlapping racial and socioeconomic inequalities. While higher-income patients possess the financial flexibility to access private healthcare providers when public systems present delays, poorer individuals face compounding barriers within the public infrastructure.
“If we look at a person, a white man or woman of better condition, they will have better access to medicines, they will have better access to treatment. Even if they cannot get an appointment in the public sector, they will pay in the private one,” Barbosa explained.
Gabriela Wünsch Lopes, a public health researcher and medical epidemiologist who reviewed the findings, noted that the study’s value lies in recognizing that these socioeconomic factors do not act in isolation. Instead, they compound to restrict marginalized populations from accessing routine health promotion and disease management resources.
Complications and Hospitalization Trends
Inadequate disease tracking and a lack of preventative care frequently allow diabetes to advance into severe complications, including cardiovascular disease, vision loss, and problems in the feet. These chronic complications can impair an individual’s ability to work, triggering a loss of income that reinforces existing social vulnerabilities.
A separate study published earlier this year in Scientific Reports demonstrated that hospitalizations for diabetes in Brazil shifted between 2010 and 2024, marked by a proportional increase in Black patients among individuals aged 40 and older admitted through the public hospital information system.
“Since the problem is not cared for at the base, and actions, guidance, and health promotion are not provided, these cases become complicated. They lead to hospitalization, amputation, and vision loss. This creates a cycle, a perpetuation of this exclusion and disadvantage,” Barbosa said.
Pathways Toward Equity in Public Health
Addressing these disparities requires public health policies to preserve the universal framework of Brazil’s Unified Health System while actively accounting for the distinct barriers faced by vulnerable demographics. Barbosa emphasizes that universal guidelines must incorporate targeted strategies for populations carrying the highest disease burdens.
“The policies are universal, they are designed in a universal way, but they need to have a vision with more attention. It is necessary, within this policy of caring for people with diabetes, to look in a differentiated way at the people who are most affected,” Barbosa concluded.
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