Inequalities in care for the people with diabetes in Brazil: A nationwide study, 2019

Abstract

The purpose of this paper is to evaluate inequalities in care for people with diabetes in Brazil. This cross-sectional population-based study was carried out in 2019 and evaluated care provided by receiving advice, requesting laboratory tests, and performing examinations. We used the slope index of inequality and concentration index to assess inequalities according to educational level and Poisson regression to estimate prevalence ratios for each outcome in the education category. We assessed a total of 6317 people with diabetes, 41.8% had their eyes checked, and 36.1% had their feet examined in the previous year. Prevalence for both examinations was 2.45 times higher in those from the highest level of education compared to those from the lowest level. The largest absolute differences (in percentage points) between the lowest and highest education levels in care indicators were the following: request for glycated hemoglobin test (39.0), glucose curve test (31.4), and eyes checked in the previous year (29.7). There were notable inequalities in the prevalence ratios of care provided to people with diabetes in Brazil. Requests for glycated hemoglobin tests, glucose curve tests, eye and feet examinations should be emphasized, especially for people from lower educational levels.

HIV Epidemic in a Province of the Brazilian Amazon Region: Temporal Trend Analysis

“…Two dispensing units of pre-exposure prophylaxis (PrEP) are located in Belém, the capital of Pará. 12 The change in the epidemiological profile of seropositive individuals as of 2012, with a high prevalence among young, homosexual, and high school individuals, was consistent with that observed on a global scale. 8 Homosexuals accounted for 17% of all new HIV infections worldwide in 2018.…”

“…In addition, primary healthcare network services have a low coverage and are mostly concentrated in urban centers. 12,13 To date, the state of Pará ranks the third lowest in Brazil's Human Development Index. 10 A study carried out in North Carolina showed that HIV late diagnosis was directly correlated with the distance of people's households to the health center where HIV screening was available.…”

“…10 Pará has the lowest coverage of primary healthcare networks, which are mainly responsible for applying HIV tests, and eight specialized healthcare centers on HIV/AIDS treatment. 11,12…”