Care and primary health care access indicators among Brazilian adults with diabetes mellitus, National Health Survey 2019

Tonaco, Luís Antônio Batista; Carrato, Bárbara Aguiar; Santos, Filipe Malta dos; Bernal, Regina Tomie Ivata; Malta, Deborah Carvalho

doi:10.1590/1980-549720260005

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 29 • 2026 • https://doi.org/10.1590/1980-549720260005 linkcopy

Care and primary health care access indicators among Brazilian adults with diabetes mellitus, National Health Survey 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To analyze indicators of access to health services and care among adults with Diabetes mellitus in Brazil, according to Primary Health Care coverage.

Methods: A cross-sectional study using data from the 2019 National Health Survey (PNS). Only individuals who self-reported a diagnosis of Diabetes mellitus were selected. Explanatory variables represented indicators of care and access among adults with a Diabetes mellitus diagnosis. Prevalence and 95% confidence intervals (95%CI) were calculated for the indicators. The association with registration in a Family Health Unit was verified by bivariate analysis. Indicators with p≤0.05 were included in a logistic regression model and, subsequently, in a model adjusted for sex and age.

Results: Among the Brazilian adult population, 8.2% (95%CI 7.9-8.6) self-reported a diagnosis of Diabetes mellitus. After adjustment, individuals with diabetes living in households registered in a Family Health Unit were more likely to have had their last consultation in a Primary Health Care Unit (OR=2.13; 95%CI 1.71-2.64), to have been seen by a specialist physician after referral (OR=1.97; 95%CI 1.49-2.60), and to report severe limitations in usual activities due to the condition (OR=1.65; 95%CI 1.05-2.62). On the other hand, they were less likely to have been seen by the same doctor as in previous consultations (OR=0.65; 95%CI 0.53-0.81) and to have undergone an eye exam in the past year (OR=0.73; 95%CI 0.58-0.90).

Conclusion: Disparities exist in care and access to Primary Health Care services among Brazilian adults with diabetes.

Keywords:
Diabetes mellitus; Health status indicators; Primary health care; Health surveys; Brazil

Indicator	% (95%CI)
Diabetes mellitus	8.2 (7.9-8.6)
Last blood glucose measurement
<6 months	24.5 (22.8-26.5)
≥6 months	75.4 (73.5-77.2)
Use of medication or insulin in the past two weeks
No	3.9 (3.2-4.9)
Yes	96 (95.1-96.8)
At least one diabetes medication through “Aqui Tem Farmácia Popular”
No	14.4 (12.9-15.9)
Yes	85.6 (84.1-87.1)
Received medical care for diabetes within the past year
No	21.1 (19.3-23)
Yes	78.9 (77-80.6)
Last consultation at an UBS
No	50.8 (48.6-52.9)
Yes	49.2 (47-51.4)
Attended by the same physician as previous consultations
No	40.8 (38.6-43)
Yes	59.2 (56.9-61.4)
All consultations with a specialist physician after referral
No	51.2 (48-54.5)
Yes	48.7 (45.5-52)
Hospitalization due to diabetes or complications
No	85.5 (84-86.8)
Yes	14.5 (13.2-16)
Severe or very severe limitations in usual activities due to diabetes
Limits a little	94.2 (92.9-95.2)
Limits intensely	5.8 (4.8-7.1)
Eye examination in the past year
No	74 (72-76)
Yes	25.9 (24-28)
Foot examination in the past year
No	64.3 (62.2-66.4)
Yes	35.7 (33.6-37.8)
N = 7,374

Indicators	Household registered in USF			Model 1		Model 2
Indicators	No	Yes	p-value	Odds Ratio % (95%CI)	p-value	Odds Ratio % (IC95%)	Valor p
Prevalence of diabetes mellitus	7.8 (7.2-8.5)	8.7 (8.3-9.1)
Care indicators: proportion
Last blood glucose measurement			0.4367
<6 months	76.7 (72.9-80.1)	75 (72.6-77.3)
Use of medication or insulin in the past two weeks			0.7037
Yes	96.4 (94.1-97.8)	96 (94.8-96.9)
At least one diabetes medication through “Aqui Tem Farmácia Popular”			0.5595
Yes	85.1 (81.8-87.9)	86.1 (84.3-87.3)
Received medical care for diabetes within the past year			0.7417
Yes	78.5 (75.2-81.5)	79.2 (76.7-81.5)
Last consultation at an UBS			<0.0001		<0.0001		<0.0001
Yes	36.8 (32.5-41.4)	55.5 (52.9-58)		2.14 (1.72-2.66)		2.13 (1.71-2.64)
Attended by the same physician as previous consultations			0.0001		<0.0001		<0.0001
Yes	66.8 (62.4-70.8)	56.7 (54.1-59.4)		0.65 (0.52-0.81)		0.65 (0.53-0.81)
All consultations with a specialist physician after referral			<0.0001		<0.0001		<0.0001
Yes	39.8 (34.4-45.4)	56.9 (52.9-60.8)		2 (1.51-2.65)		1.97 (1.49-2.60)
Hospitalization due to diabetes or complications			0.0139
Yes	11.5 (9.3-14.2)	15.6 (13.9-17.6)
Severe or very severe limitations in usual activities due to diabetes			0.0293		0.031		0.031
Limits intensely	4.1 (2.9-5.9)	6.9 (5.2-8.5)		1.65 (1.05-2.60)		1.65 (1.05-2.62)
Eye examination in the past year			0.0043		0.004		0.005
Yes	30.1 (27.2-35)	24.5 (22.1-27)		0.72 (0.56-0.91)		0.73 (0.58-0.90)
Foot examination in the past year			0.5652
Yes	36.6 (32.6-40.8)	35.2 (32.7-37.8)

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