How much the burden of diabetes and hypertension is attributable to social inequalities? an intersectional analysis in Brazil

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.