Banca de QUALIFICAÇÃO: FÁBIA CHEYENNE GOMES DE MORAIS FERNANDES

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : FÁBIA CHEYENNE GOMES DE MORAIS FERNANDES
DATE: 10/06/2026
TIME: 08:30
LOCAL: Remoto
TITLE:

Social Markers of Difference in Diabetes Care in Brazil: An Intersectional Approach to Gender, Race, and Socioeconomic Status

KEY WORDS:

Diabetes Mellitus; Intersectionality; Health Services Accessibility.

PAGES: 130
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Epidemiologia
SUMMARY:

Introduction: Diabetes mellitus is a major global public health problem, associated with a high burden of morbidity and mortality and multiple disease-related complications, posing significant challenges to health systems. Objective: To analyze inequities in diabetes mellitus care and related outcomes in Brazil, considering the intersection of gender, race, and socioeconomic status. Methods: Article 1: a cross-sectional study based on data from the Brazilian National Health Survey (Pesquisa Nacional de Saúde – PNS) (2019–2020), including 6,967 adults with self-reported diabetes. Adequacy of care was analyzed according to sociodemographic characteristics using an intersectional approach. Poisson regression with robust variance was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). Article 2: an ecological study using data from the Hospital Information System of the Brazilian Unified Health System (Sistema Único de Saúde – SUS). Trends in hospitalization rates and proportions due to diabetes mellitus according to race, gender, and geographic distribution were analyzed using Joinpoint Regression. Article 3: a cross-sectional study using data from Vigitel 2017–2019. Access to medications for diabetes treatment among older adults was analyzed using absolute and relative measures of inequality. Results: In Article 1, Black low-income women represented the predominant profile among individuals with diabetes (22.0%; 95%CI: 20.5–23.3). The highest prevalence of poor adequacy of care was observed among low-income Black men (79.6%; 95%CI: 75.7–83.1) and Black women (79.1%; 95%CI: 76.2–81.8). In the multivariate model, poor adequacy of care was associated with low-income Black women (PR=1.09) and men (PR=1.10), absence of diabetes-related complications (PR=1.18), and no history of hospitalization due to diabetes (PR=1.12). In Article 2, diabetes-related hospitalization rates in Brazil showed a decreasing trend until 2020 (APC= -4.2%; 95%CI: -4.8; -3.6), followed by stabilization. An increasing trend in the proportion of hospitalizations was observed among Black women and Black men, particularly in the North and Northeast regions. In Article 3, older Black women (aPR=0.98; 95%CI: 0.97–0.99) had lower access to medications compared with older White women; older adults who self-rated their health as “poor” (aPR=0.97; 95%CI: 0.95–0.99) and those without private health insurance (PR=0.98; 95%CI: 0.97–0.99) also had lower access to medications. Inequality measures highlighted disparities in access to diabetes medications among older Black women with poor self-rated health compared with those reporting good health [SII of -7.63 pp (95%CI: -14.27; -0.99), RII of 0.92 (95%CI: 0.85–0.99), PAR of -7.63 pp, and PAF of -8.97%]. Final considerations: The combined findings demonstrate that diabetes mellitus care in Brazil remains marked by structural inequities associated with the intersection of gender, race, socioeconomic, and geographic conditions. These results reinforce the need for equity-oriented health policies and care practices.

COMMITTEE MEMBERS:
Presidente - 2305247 - ISABELLE RIBEIRO BARBOSA MIRABAL
Interno - 3926907 - DYEGO LEANDRO BEZERRA DE SOUZA
Externa ao Programa - 1692571 - ANNA CECILIA QUEIROZ DE MEDEIROS - UFRN