Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
- −
- North (Acre, Amapá, Amazonas, Pará, Rondônia, Roraima, and Tocantins),
- −
- Northeast (Alagoas, Bahia, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, and Sergipe),
- −
- Midwest (Goiás, Mato Grosso, and Mato Grosso do Sul),
- −
- Southeast (São Paulo, Minas Gerais, Rio de Janeiro, and Espírito Santo), and
- −
- South (Paraná, Santa Catarina, and Rio Grande do Sul).
2.2. Study Population
- (a)
- homeless individuals—native or naturalized Brazilians who had lived on public streets, in shelters, or in similar locations designated for this population for at least six months during the COVID-19 pandemic;
- (b)
- migrants and refugees—individuals from other countries who had resided in Brazil for at least six months during the pandemic and had basic proficiency in interpreting or understanding the Portuguese language;
- (c)
- residents of slums—native or naturalized Brazilians living in urban areas characterized by inadequate housing and poor infrastructure (such as favelas, informal settlements, or urban occupations) during the pandemic;
- (d)
- residents of camps, settlements, or occupations—native or naturalized Brazilians who had lived in these areas for at least six months during the pandemic.
2.3. Sampling
2.4. Healthcare System in Brazil
2.5. Survey Questionnaire and Data Collection Procedure
2.6. Data Collected and Study Variables
- Sex/Gender: Male, Female, Transgender, or Other;
- Age Group: 18–29 years, 30–59 years, or 60 years and older;
- Race/Ethnicity: White, Black/Brown, Indigenous, or Asian;
- Marital Status: Married/In a Stable Union, Widowed, Separated, or Single;
- Education Level: No Formal Education, Incomplete Primary Education, Complete Primary Education, Incomplete Higher Education, or Higher Education;
- Employment Status: Formal Employment, Informal Employment, Unemployed, Student, Retired, or Other;
- Monthly Income: No income, Less than one minimum wage, One to two minimum wages, Two to three minimum wages, or More than three minimum wages;
- Receipt of Government Assistance: Yes or No.
- Utilization of Public Healthcare Services: Yes or No;
- Utilization of Private Healthcare Services: Yes or No.
2.7. Statistical Analysis
2.8. Ethical Aspects
3. Results
3.1. Demographics
3.2. Regression and Proportions Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | n (%) |
---|---|
Sex/Gender | |
Male | 2045 (60.0) |
Female Transgender | 1302 (38.2) 53 (1.6) |
Others | 5 (0.1) |
No reply | 1 (0.0) |
Age (years) | |
18 to 29 | 877 (25.7) |
30 to 59 | 2218 (65.1) |
60 years or older | 311 (9.1) |
Race/color | |
White | 747 (22.0) |
Black/brown | 2460 (72.2) |
Indigenous | 63 (1.8) |
Asian | 102 (3.0) |
No reply | 34 (1.0) |
Marital status | |
Married or in a stable union | 987 (29.0) |
Widowed, separated, or single | 2418 (71.0) |
No reply | 1 (0.0) |
Education | |
No formal education | 145 (4.3) |
Complete primary education | 1483 (43.5) |
Completed high school | 1329 (39.0) |
Complete university or post-graduate degree | 447 (13.1) |
No reply | 2 (0.1) |
Occupation/Employment | |
Formal employment | 490 (14.3) |
Informal employment | 1102 (32.4) |
Unemployed | 1328 (39.0) |
Student | 143 (4.2) |
Retired/Pensioner | 187 (5.5) |
Others | 155 (4.6) |
No reply | 1 (0.0) |
Monthly income | |
No income | 833 (24.5) |
Less than 1 minimum wage | 1267 (37.2) |
From 1 to 2 minimum wages | 746 (21.9) |
From 2 to 3 minimum wages | 184 (5.4) |
Above 3 minimum wages | 116 (3.4) |
No reply | 260 (7.6) |
Receives government aid | |
Yes | 1460 (42.9) |
No | 1943 (57.0) |
No reply | 3 (0.1) |
Utilization of Public Healthcare Services | |
Yes | 3112 (91.4) |
No | 284 (8.3) |
No reply | 10 (0.3) |
Utilization of Private Healthcare Services | |
Yes | 222 (6.5) |
No | 3167 (92.9) |
No reply | 17 (0.6) |
Variable | Odds Ratio [95% CI] | Marginal Effect | p-Value |
---|---|---|---|
0—Male, White, Higher Education | - | 0.759 | Ref |
1—Woman, White, Higher Education | 4.69 [1.91–11.5] | 0.891 | 0.001 ** |
2—Woman, Asian or Black, Incomplete Higher Education | 3.45 [1.43–8.33] | 0.936 | 0.006 ** |
3—Cisgender Woman/Transgender person, Asian or Black, Complete Primary Education | 3.15 [1.31–7.58] | 0.916 | 0.010 * |
4—Cisgender Woman/Transgender person, Black, Incomplete Primary Education | 4.16 [1.60–10.7] | 0.908 | 0.003 ** |
5—Cisgender Woman/Transgender person, Black, No Formal Education | 3.14 [1.34–7.35] | 0.929 | 0.008 ** |
Variable | Odds Ratio [95% CI] | Marginal Effect | p-Value |
---|---|---|---|
0—Male, White, Higher Education | - | 0.479 | Ref |
1—Woman, White, Higher Education | 0.26 [0.11–0.06] | 0.210 | 0.002 ** |
2—Woman, Asian or Black, Incomplete Higher Education | 0.12 [0.05–0.28] | 0.128 | 0.00 *** |
3—Cisgender Woman/Transgender person, Asian or Black, Complete Primary Education | 0.05 [0.02–0.13] | 0.067 | 0.00 *** |
4—Cisgender Woman/Transgender person, Black, Incomplete Primary Education | 0.04 [0.20–0.98] | 0.035 | 0.040 * |
5—Cisgender Woman/Transgender person, Black, No Formal Education | 0.07 [0.02–0.20] | 0.053 | 0.00 *** |
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Share and Cite
Ferezin, L.P.; Rosa, R.J.; Moura, H.S.D.; de Campos, M.C.T.; Delpino, F.M.; Nascimento, M.C.d.; Araújo, J.S.T.d.; Pinto, I.C.; Arcêncio, R.A. Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis. Int. J. Environ. Res. Public Health 2025, 22, 831. https://doi.org/10.3390/ijerph22060831
Ferezin LP, Rosa RJ, Moura HSD, de Campos MCT, Delpino FM, Nascimento MCd, Araújo JSTd, Pinto IC, Arcêncio RA. Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis. International Journal of Environmental Research and Public Health. 2025; 22(6):831. https://doi.org/10.3390/ijerph22060831
Chicago/Turabian StyleFerezin, Letícia Perticarrara, Rander Junior Rosa, Heriederson Sávio Dias Moura, Mônica Chiodi Toscano de Campos, Felipe Mendes Delpino, Murilo César do Nascimento, Juliana Soares Tenório de Araújo, Ione Carvalho Pinto, and Ricardo Alexandre Arcêncio. 2025. "Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis" International Journal of Environmental Research and Public Health 22, no. 6: 831. https://doi.org/10.3390/ijerph22060831
APA StyleFerezin, L. P., Rosa, R. J., Moura, H. S. D., de Campos, M. C. T., Delpino, F. M., Nascimento, M. C. d., Araújo, J. S. T. d., Pinto, I. C., & Arcêncio, R. A. (2025). Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis. International Journal of Environmental Research and Public Health, 22(6), 831. https://doi.org/10.3390/ijerph22060831