How much the burden of diabetes and hypertension is attributable to social inequalities? an intersectional analysis in Brazil
Abstract
Objective: This study aimed to analyze the association between the intersectionality of sex, race/color, educational attainment, and the occurrence of diabetes, hypertension and both (diabetes and hypertension) among adults, using data from the 2023 Brazilian Vigitel National Survey.
Methods: A cross-sectional study was conducted using data from Vigitel 2023, which included 21,690 individuals aged ≥ 18 years. The outcomes were self-reported diabetes mellitus, hypertension, and the co-occurrence of both conditions. The exposures of interest were sex, race/color, and educational attainment. Analyses were guided by the “multiple jeopardy” framework (Jeopardy Index) to assess the intersectionality of these social markers, using chi-square test and Poisson regression.
Results: Black, Brown (mixed-race), Asian, and Indigenous women with low educational attainment had a four-fold higher probability of presenting with both conditions, a three-fold higher probability of diabetes, and a 2.3-fold higher probability of hypertension than that of white men with high educational attainment. Individuals with low educational attainment exhibited a higher prevalence of all assessed morbidities, regardless of sex or race/color. It was estimated that 34.6%, 21.6%, and 44.2% of cases of diabetes, hypertension, and co-occurring diabetes/hypertension, respectively, were attributable to low educational attainment.
Conclusions: Social and racial markers of inequality are associated with the coexistence of diabetes and hypertension in Brazil. Low educational attainment emerged as a key social determinant of these conditions. Therefore, prevention and control strategies should incorporate actions aimed at addressing these structural vulnerabilities into public health policies.
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BibTeX
@article{neves2026much,
title = {{How much the burden of diabetes and hypertension is attributable to social inequalities? an intersectional analysis in Brazil}},
author = {Rosália Garcia Neves and Niely Galeão da Rosa Moraes and Bruna Leite Brum and Lizandro Pereira Miranda and Romina Buffarini and Elizabet Saes-Silva and Mirelle de Oliveira Saes},
journal = {BMC Public Health},
year = {2026},
month = oct,
doi = {10.1186/s12889-026-29369-8},
url = {https://link.springer.com/article/10.1186/s12889-026-29369-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - How much the burden of diabetes and hypertension is attributable to social inequalities? an intersectional analysis in Brazil
AU - Rosália Garcia Neves
AU - Niely Galeão da Rosa Moraes
AU - Bruna Leite Brum
AU - Lizandro Pereira Miranda
AU - Romina Buffarini
AU - Elizabet Saes-Silva
AU - Mirelle de Oliveira Saes
PY - 2026
DA - 2026/10/16
JO - BMC Public Health
DO - 10.1186/s12889-026-29369-8
UR - https://link.springer.com/article/10.1186/s12889-026-29369-8
AB - Objective: This study aimed to analyze the association between the intersectionality of sex, race/color, educational attainment, and the occurrence of diabetes, hypertension and both (diabetes and hypertension) among adults, using data from the 2023 Brazilian Vigitel National Survey. Methods: A cross-sectional study was conducted using data from Vigitel 2023, which included 21,690 individuals aged ≥ 18 years. The outcomes were self-reported diabetes mellitus, hypertension, and the co-occurrence of both conditions. The exposures of interest were sex, race/color, and educational attainment. Analyses were guided by the “multiple jeopardy” framework (Jeopardy Index) to assess the intersectionality of these social markers, using chi-square test and Poisson regression. Results: Black, Brown (mixed-race), Asian, and Indigenous women with low educational attainment had a four-fold higher probability of presenting with both conditions, a three-fold higher probability of diabetes, and a 2.3-fold higher probability of hypertension than that of white men with high educational attainment. Individuals with low educational attainment exhibited a higher prevalence of all assessed morbidities, regardless of sex or race/color. It was estimated that 34.6%, 21.6%, and 44.2% of cases of diabetes, hypertension, and co-occurring diabetes/hypertension, respectively, were attributable to low educational attainment. Conclusions: Social and racial markers of inequality are associated with the coexistence of diabetes and hypertension in Brazil. Low educational attainment emerged as a key social determinant of these conditions. Therefore, prevention and control strategies should incorporate actions aimed at addressing these structural vulnerabilities into public health policies.
SN - 1471-2458
ER -