Post-COVID-19 social determinants of health and quality of life: a longitudinal study

Florencio, Sabrina de Souza Gurgel; Lima, Francisca Elisângela Teixeira; Lima, Glaubervania Alves; Fontenele, Maria Gabriela Miranda; Pascoal, Lívia Maia; Sandoval, Lilia Jannet Saldarriaga; Almeida, Paulo César de; Felipe, Gilvan Ferreira; Ventura, Maria Williany Silva; Oliveira, Brena Shellem Bessa de; Barbosa, Lorena Pinheiro

doi:10.1590/1980-220X-REEUSP-2025-0565en

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 60 • 2026 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0565en linkcopy

Post-COVID-19 social determinants of health and quality of life: a longitudinal study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To verify the association between the social determinants of health and quality of life domains in people in a post-COVID-19 condition.

Methods: A longitudinal study was conducted with 179 people from the states of Ceará and Maranhão, followed for six months after a confirmed diagnosis of COVID-19. Data collection was performed using a link for COVID-19 patients monitoring software, sent monthly via phone messaging app. Variables related to the social determinants of health and the domains of the SF-36 questionnaire for assessing quality of life are considered. Data analyzed using descriptive and inferential statistics.

Results: Women showed improvements in the pain domain between the 2nd and 4th month (p = 0.038), vitality between the 4th and 6th month (p = 0.035), and mental health between the 2nd and 6th month (p = 0.005). Men showed better recovery in overall health status at 2 and 4 months (p = 0.029) and in social aspects at 2 and 6 months (p = 0.040).

Conclusion: Progressive improvement in quality of life was observed throughout the follow-up period, with differences between men and women in the areas of pain, vitality, mental health, general health status, and social aspects.

DESCRIPTORS
COVID-19; Social Determinants of Health; Quality of Life; Nursing; Public Health

SF-36 domains	Total		Functional capacity average (±SD)				Limitations due to physical aspects average (±SD)
SF-36 domains	n	%	2nd month	4th month	6th month	p*	2nd month	4th month	6th month	p*
Layer 1 – Age, sex, and hereditary factors
Age
20–39	114	63.7	83.4 (±20.4)	83.7 (±19.2)	84.2 (±18.4)	0.905	76.5 (±35.7)	82.2 (±30.9)	84.2 (±27.6)	0.070
40–59	56	31.3	75.8 (±22.8)	76.9 (±23.6)	78.8 (±21.2)	0.038	71.4 (±37.9)	73.2 (±38.6)	74.5 (±36.1)	0.645
60–75	9	5.0	66.6 (±25.1)	68.3 (±23.3)	69.4 (±16.2)	0.747	66.6 (±45.0)	75.0 (±39.5)	69.4 (±46.3)	0.819
p-value §			0.008	0.034	0.027		0.634	0.432	0.254
Sex
Male	105	58.7	87.4 (±17.0)	86.6 (±18.5)	88.1 (±17.1)	0.591	80.0 (±34.8)	88.5 (±25.5)	89.8 (±23.0)	0.038
Female	74	41.3	75.1 (±23.4)	76.6 (±22.1)	77.4 (±19.9)	0.331	70.4 (±37.7)	72.3 (±37.6)	73.8 (±35.4)	0.467
p-value †			<0.001	0.001	<0.001		0.042	0.002	0.001
Race/Color
White	57	31.8	79.3 (±26.4)	80.5 (±22.2)	83.0 (±20.2)	0.560	74.5 (±39.1)	76.3 (±33.8)	77.6 (±32.2)	0.672
Black	21	11.7	80.0 (±21.8)	78.8 (±23.6)	76.1 (±20.9)	0.115	71.4 (±35.6)	70.2 (±40.7)	80.9 (±34.3)	0.353
Brown	101	56.4	80.7 (±18.9)	81.4 (±20.3)	82.3 (±18.7)	0.383	75.0 (±36.0)	82.4 (±32.5)	81.9 (±31.2)	0.024
p-value §			0.745	0.951	0.307		0.754	0.208	0.549
2nd layer – Individuals’ lifestyle
Physical activity/week
0 to 3 days	145	81.0	78.6 (±21.9)	79.2 (±21.6)	80.5 (±19.7)	0.236	71.5 (±37.8)	79.3 (±34.1)	81.5 (±30.7)	<0.001
4 to 7 days	34	19.0	86.9 (±20.1)	87.9 (±18.3)	87.3 (±17.7)	0.500	86.7 (±29.6)	77.9 (±34.1)	75.7 (±36.1)	0.026
p-value †			0.010	0.010	0.042		0.009	0.832	0.583
Fruit and vegetable consumption/week
0 to 3 days	94	52.5	78.3 (±21.6)	79.8 (±20.8)	80.7 (±19.7)	0.179	76.5 (±34.5)	78.9 (±32.4)	81.1 (±29.9)	0.300
4 to 7 days	85	47.5	82.2 (±21.9)	81.9 (±21.7)	83.0 (±19.2)	0.805	72.0 (±39.2)	79.1 (±35.9)	79.7 (±33.9)	0.121
p-value †			0.071	0.280	0.391		0.760	0.686	0.810
Consumption of fried and processed foods/week
0 to 3 days	131	73.2	79.3 (±22.5)	81.1 (±21.9)	83.0 (±19.2)	0.026	75.0 (±35.7)	79.0 (±33.9)	79.9 (±31.5)	0.082
4 to 7 days	48	26.8	82.5 (±19.5)	80.1 (±19.3)	78.6 (±20.1)	0.136	72.9 (±39.8)	79.1 (±34.7)	81.7 (±32.9)	0.353
p-value †			0.420	0.912	0.119		0.818	0.482	0.510
Sun exposure/week
0 to 3 days	109	60.9	79.0 (±22.0)	82.1 (±19.5)	82.1 (±18.9)	0.110	78.8 (±32.6)	81.6 (±31.1)	81.8 (±30.2)	0.202
4 to 7 days	70	39.1	82.0 (±21.4)	78.8 (±23.6)	81.3 (±20.4)	0.580	67.5 (±41.7)	75.0 (±38.0)	78.2 (±34.2)	0.198
p-value †			0.254	0.636	0.922		0.147	0.334	0.589
Difficulty sleeping
Yes	99	55.3	77.4 (±22.8)	80.5 (±21.4)	79.9 (±20.7)	0.170	82.1 (±31.3)	85.0 (±29.9)	85.9 (±26.3)	0.133
No	80	44.7	83.6 (±20.0)	81.3 (±21.0)	84.1 (±17.7)	0.591	68.1 (±39.7)	74.2 (±36.5)	76.0 (±35.1)	0.340
p-value †			0.035	0.748	0.244		0.019	0.022	0.059
Smoking
Yes	8	4.5	86.2 (±24.0)	90.6 (±10.5)	87.5 (±18.5)	0.953	100 (±00.0)	90.6 (±26.5)	100 (±00.0)	0.368
No	171	95.5	79.9 (±21.7)	80.4 (±21.5)	81.5 (±19.5)	0.427	73.2 (±37.2)	78.5 (±34.3)	79.5 (±32.2)	0.041
p-value †			0.167	0.319	0.337		0.019	0.224	0.043
Alcoholism
Yes	79	44.1	83.1 (±20.3)	83.2 (±19.9)	84.3 (±18.0)	0.756	76.8 (±35.0)	82.2 (±30.7)	85.1 (±27.8)	0.164
No	100	55.9	77.9 (±22.7)	79.0 (±22.1)	79.9 (±20.4)	0.160	72.5 (±38.1)	76.5 (±36.3)	76.7 (±34.3)	0.256
p-value †			0.136	0.274	0.211		0.461	0.388	0.126
3rd layer – Social and community networks
Number of people residing in the household
Lives alone or one	9	5.0	75.5 (±23.7)	76.1 (±25.0)	78.8 (±26.1)	0.857	72.2 (±42.2)	72.2 (±44.0)	91.6 (±17.6)	0.779
≥ 2	170	95.0	80.4 (±21.7)	81.1 (±21.0)	82.0 (±19.1)	0.481	74.5 (±36.6)	79.4 (±33.5)	79.8 (±32.3)	0.043
p-value †			0.471	0.551	0.970		0.819	0.802	0.351
Lives with people in the at-risk group
Yes	90	50.3	79.4 (±21.6)	80.7 (±20.7)	82.3 (±20.0)	0.819	73.3 (±37.8)	80.2 (±33.6)	80.8 (±32.4)	0.018
No	89	49.7	80.9 (±22.0)	80.9 (±21.8)	81.3 (±19.0)	0.114	75.5 (±35.9)	77.8 (±34.6)	80.0 (±31.3)	0.416
p-value †			0.525	0.678	0.717		0.687	0.597	0.815
4th layer – Living conditions
Water supply
Distribution network	168	93.9	81.1 (±20.2)	81.5 (±21.0)	82.3 (±19.1)	0.387	74.1 (±36.9)	80.0 (±33.5)	81.5 (±30.4)	0.017
Other	11	6.1	66.8 (±37.7)	70.4 (±22.6)	74.0 (±24.5)	0.882	79.5 (±35.0)	63.6 (±39.3)	63.6 (±46.5)	0.444
p-value †			0.508	0.054	0.276		0.642	0.119	0.212
Sewer drain
Sewer system	120	67.0	79.7 (±20.7)	81.5 (±19.6)	81.5 (±19.3)	0.526	73.9 (±36.8)	80.6 (±33.2)	81.6 (±29.6)	0.042
Other	59	33.0	81.2 (±24.0)	79.5 (±24.2)	82.5 (±19.9)	0.853	75.4 (±36.9)	75.8 (±35.6)	77.9 (±35.9)	0.764
p-value †			0.293	0.861	0.465		0.537	0.446	0.922
5th layer – General socioeconomic, cultural and environmental conditions
Family income
< 3 minimum wages	107	59.8	78.8 (±22.3)	79.5 (±21.4)	79.7 (±20.4)	0.598	73.5 (±37.7)	80.3 (±32.5)	81.3 (±31.6)	0.027
>3 minimum wages	72	40.2	82.2 (±20.9)	82.8 (±20.9)	85.0 (±17.6)	0.532	75.6 (±35.5)	77.0 (±36.2)	79.1 (±32.2)	0.856
p-value †			0.311	0.299	0.142		0.843	0.711	0.510

SF-36 domains	Pain average (±SD)				General health status average (±SD)				Vitality average (±SD)
SF-36 domains	2nd month	4th month	6th month	p*	2nd month	4th month	6th month	p*	2nd month	4th month	6th month	p*
Layer 1 – Age, sex, and hereditary factors
Age
20–39	72.5 (±23.1)	73.5 (±22.4)	74.4 (±22.4)	0.514	64.4 (±20.5)	65.5 (±20.6)	66.4 (±21.2)	0.507	53.7 (±18.9)	54.3 (±22.0)	56.4 (±19.9)	0.246
40–59	66.4 (±24.4)	70.5 (±23.2)	72.0 (±23.6)	0.015	64.0 (±17.3)	68.7 (±18.3)	66.1 (±19.2)	0.096	56.8 (±19.4)	60.0 (±19.4)	62.2 (±19.0)	0.006
60–75	60.3 (±18.3)	65.1 (±27.5)	53.0 (±11.0)	0.485	52.3 (±8.9)	54.7 (±10.9)	55.3 (±12.2)	0.678	52.2 (±12.0)	53.8 (±13.8)	56.6 (±13.2)	0.482
p-value §	0.155	0.555	0.016		0.090	0.074	0.152		0.563	0.278	0.217
Sex
Male	76.3 (±22.5)	75.8 (±22.4)	78.0 (±21.4)	0.555	68.2 (±17.6)	72.0 (±18.9)	71.1 (±18.3)	0.045	61.4 (±19.3)	64.3 (±20.2)	63.9 (±18.6)	0.161
Female	65.6 (±23.2)	69.5 (±23.0)	68.8 (±23.1)	0.035	60.5 (±19.8)	61.7 (±19.2)	62.0 (±20.9)	0.839	49.8 (±16.9)	50.3 (±19.6)	54.3 (±19.1)	0.009
p-value †	0.003	0.068	0.009		0.013	<0.001	0.004		<0.001	<0.001	0.001
Race/Color
White	64.1 (±26.2)	69.6 (±24.4)	70.9 (±24.5)	0.036	62.2 (±22.8)	64.2 (±23.2)	63.2 (±22.4)	0.064	53.7 (±21.1)	54.0 (±22.4)	53.5 (±20.5)	0.856
Black	72.5 (±22.4)	65.5 (±24.0)	75.3 (±21.5)	0.220	62.2 (±16.3)	63.8 (±19.2)	62.2 (±12.7)	0.334	55.0 (±18.5)	52.1 (±23.6)	53.8 (±18.9)	0.776
Brown	72.8 (±21.6)	74.9 (±21.6)	73.0 (±22.1)	0.073	64.8 (±17.6)	67.4 (±17.6)	67.9 (±20.2)	0.035	55.0 (±17.6)	58.1 (±19.5)	61.8 (±18.3)	<0.001
p-value §	0.131	0.199	0.825		0.771	0.603	0.161		0.925	0.402	0.024
2nd layer – Individuals’ lifestyle
Physical activity/week
0 to 3 days	68.2 (±23.3)	70.2 (±22.7)	71.7 (±23.0)	0.048	62.8 (±18.9)	64.6 (±19.3)	64.7 (±19.8)	0.215	53.3 (±19.0)	54.8 (±21.5)	57.6 (±19.7)	0.015
4 to 7 days	77.7 (±22.7)	80.1 (±22.3)	76.3 (±21.8)	0.530	67.4 (±20.7)	72.1 (±20.4)	70.1 (±21.9)	0.512	60.1 (±17.1)	61.4 (±18.0)	60.8 (±18.4)	0.539
p-value †	0.028	0.021	0.312		0.257	0.059	0.159		0.050	0.125	0.402
Fruit and vegetable consumption/week
0 to 3 days	69.9 (±23.0)	71.6 (±21.9)	72.1 (±22.8)	0.174	61.1 (±20.0)	64.4 (±19.8)	62.9 (±20.7)	0.215	54.2 (±18.2)	55.7 (±21.8)	58.2 (±19.7)	0.056
4 to 7 days	70.2 (±24.1)	72.6 (±24.0)	73.1 (±22.9)	0.208	66.5 (±18.1)	67.8 (±19.5)	68.8 (±19.5)	0.589	55.1 (±19.4)	56.4 (±20.1)	58.2 (±19.3)	0.150
p-value †	0.831	0.610	0.699		0.084	0.278	0.069		0.754	0.871	0.853
Consumption of fried and processed foods/week
0 to 3 days	70.4 (±23.4)	72.9 (±23.0)	73.4 (±22.2)	0.168	64.4 (±19.1)	67.2 (±18.5)	67.3 (±19.7)	0.235	55.1 (±18.4)	56.6 (±21.0)	59.7 (±19.0)	0.006
4 to 7 days	69.1 (±23.7)	69.8 (±22.6)	70.5 (±24.3)	0.184	61.7 (±19.7)	62.7 (±22.4)	61.3 (±21.4)	0.344	53.2 (±19.8)	54.5 (±21.0)	54.2 (±20.2)	0.779
p-value †	0.754	0.278	0.557		0.548	0.539	0.097		0.500	0.397	0.139
Sun exposure/week
0 to 3 days	71.2 (±23.7)	73.1 (±22.6)	73.3 (±22.7)	0.168	63.1 (±19.1)	66.4 (±19.1)	65.8 (±20.2)	0.041	54.8 (±17.7)	57.4 (±21.0)	60.0 (±18.1)	0.007
4 to 7 days	68.1 (±23.2)	70.6 (±23.4)	71.6 (±22.9)	0.214	64.6 (±19.5)	65.4 (±20.7)	65.6 (±20.5)	0.983	54.4 (±20.5)	54.0 (±20.9)	55.6 (±21.2)	0.593
p-value †	0.323	0.509	0.670		0.501	0.896	0.895		0.999	0.340	0.200
Difficulty sleeping
Yes	66.8 (±24.5)	69.4 (±23.1)	70.1 (±23.0)	0.011	60.4 (±18.5)	63.6 (±20.1)	64.2 (±20.6)	0.039	51.3 (±19.6)	53.7 (±21.5)	54.7 (±20.4)	0.127
No	74.0 (±21.7)	75.5 (±22.3)	75.6 (±22.2)	0.860	67.8 (±19.5)	68.9 (±18.9)	67.6 (±19.8)	0.279	58.8 (±16.9)	59.0 (±20.1)	62.6 (±17.3)	0.053
p-value †	0.045	0.099	0.118		0.010	0.074	0.368		0.008	0.060	0.010
Smoking
Yes	79.7 (±24.0)	67.5 (±24.9)	79.6 (±16.2)	0.228	69.8 (±20.1)	62.3 (±15.4)	63.3 (±26.0)	0.058	60.0 (±17.5)	61.8 (±17.5)	68.1 (±16.4)	0.040
No	69.6 (±23.4)	72.3 (±22.9)	72.3 (±22.0)	0.014	63.4 (±19.2)	66.2 (±19.9)	65.8 (±20.1)	0.326	54.4 (±18.8)	55.8 (±21.1)	57.8 (±19.5)	0.035
p-value †	0.243	0.481	0.455		0.452	0.561	0.740		0.408	0.449	0.169
Alcoholism
Yes	73.8 (±23.5)	72.6 (±22.7)	75.3 (±21.1)	0.618	66.2 (±19.5)	66.7 (±19.3)	69.1 (±18.2)	0.377	56.0 (±18.6)	55.6 (±21.5)	59.3 (±20.4)	0.374
No	67.0 (±23.1)	71.7 (±23.2)	70.4 (±23.9)	0.008	61.7 (±18.9)	65.4 (±20.0)	63.1 (±21.5)	0.091	53.5 (±18.9)	58.5 (±20.6)	57.4 (±18.7)	0.012
p-value †	0.060	0.801	0.216		0.125	0.826	0.092		0.376	0.903	0.414
3rd layer – Social and community networks
Number of people residing in the household
Lives alone or one	63.0 (±22.6)	69.0 (±22.8)	72.5 (±24.9)	0.152	59.8 (±19.0)	63.4 (±20.0)	61.8 (±27.7)	0.401	53.3 (±16.0)	54.4 (±20.6)	65.0 (±22.0)	0.087
≥ 2	70.4 (±23.5)	72.3 (±22.8)	72.6 (±22.7)	0.091	63.9 (±19.3)	66.1 (±19.7)	65.9 (±19.9)	0.169	54.7 (±18.9)	56.2 (±21.1)	57.9 (±19.3)	0.025
p-value †	0.335	0.705	0.973		0.335	0.501	0.756		0.804	0.796	0.255
Lives with people in the at-risk group
Yes	70.1 (±22.5)	72.2 (±22.1)	73.1 (±22.3)	0.273	64.6 (±20.1)	65.4 (±19.5)	67.3 (±19.8)	0.131	55.0 (±18.4)	53.7 (±21.2)	58.8 (±19.2)	0.026
No	69.9 (±24.5)	72.0 (±23.8)	72.1 (±23.3)	0.115	62.7 (±18.4)	66.5 (±19.9)	64.1 (±20.8)	0.026	54.3 (±19.3)	58.4 (±20.7)	57.6 (±19.7)	0.011
p-value †	0.913	0.984	0.781		0.461	0.648	0.359		0.729	0.271	0.791
4th layer – Living conditions
Water supply
Distribution network	70.1 (±23.2)	71.8 (±22.9)	72.6 (±22.9)	0.062	63.6 (±19.3)	66.1 (±19.8)	65.7 (±20.4)	0.109	54.8 (±18.9)	56.6 (±21.0)	58.7 (±19.5)	0.009
Other	68.1 (±27.7)	76.7 (±23.2)	77.2 (±20.9)	0.422	65.2 (±19.5)	64.0 (±18.2)	66.6 (±18.8)	1.000	51.3 (±17.3)	48.6 (±20.5)	50.9 (±17.8)	0.773
p-value †	0.887	0.450	0.966		0.675	0.711	0.873		0.613	0.233	0.204
Sewer drain
Sewer system	68.6 (±23.5)	71.6 (±23.0)	71.7 (±23.6)	0.045	63.6 (±19.2)	65.7 (±20.3)	65.6 (±20.1)	0.182	53.3 (±18.1)	53.7 (±19.8)	56.9 (±18.5)	0.017
Other	72.9 (±23.2)	73.2 (±22.9)	74.5 (±21.0)	0.622	63.8 (±19.4)	66.7 (±18.5)	66.1 (±20.9)	0.640	57.3 (±20.0)	61.0 (±22.6)	61.1 (±21.1)	0.302
p-value †	0.216	0.623	0.434		0.881	0.746	0.866		0.155	0.023	0.195
5th layer – General socioeconomic, cultural and environmental conditions
Family income
< 3 minimum wages	70.8 (±23.6)	73.9 (±22.8)	73.4 (±23.4)	0.150	63.4 (±18.8)	65.1 (±19.5)	63.8 (±20.4)	0.468	54.8 (±19.6)	57.0 (±21.3)	57.7 (±20.1)	0.048
>3 minimum wages	68.9 (±23.4)	69.4 (±23.0)	71.4 (±22.0)	0.109	64.0 (±20.1)	67.3 (±19.9)	68.5 (±20.0)	0.130	54.4 (±17.5)	54.7 (±20.5)	59.0 (±18.5)	0.034
p-value †	0.593	0.197	0.455		0.664	0.433	0.123		0.972	0.473	0.656

SF-36 domains	Social aspects average (±SD)				Emotional aspects average (±SD)				Mental health average (±SD)
SF-36 domains	2nd month	4th month	6th month	p*	2nd month	4th month	6th month	p*	2nd month	4th month	6th month	p*
Layer 1 – Age, sex, and hereditary factors
Age
20–39	70.5 (±24.7)	73.3 (±24.8)	72.5 (±24.4)	0.220	63.4 (±40.1)	71.6 (±37.1)	70.7 (±38.4)	0.025	60.3 (±18.6)	63.5 (±19.3)	65.5 (±20.3)	0.013
40–59	72.3 (±23.9)	77.0 (±25.4)	79.0 (±23.2)	0.002	76.7 (±37.0)	74.4 (±40.1)	75.5 (±38.9)	0.705	64.0 (±19.7)	65.2 (±21.5)	67.5 (±19.5)	0.204
60–75	63.8 (±20.1)	69.4 (±26.5)	79.1 (±22.5)	0.125	59.2 (±49.3)	62.9 (±48.4)	77.7 (±44.0)	0.368	53.3 (±12.6)	53.7 (±15.1)	60.4 (±15.9)	0.042
p-value §	0.508	0.479	0.212		0.056	0.596	0.537		0.163	0.240	0.482
Sex
Male	77.5 (±22.5)	80.9 (±20.5)	81.9 (±21.4)	0.014	76.5 (±34.7)	82.8 (±30.8)	83.7 (±31.8)	0.179	68.3 (±17.6)	70.9 (±19.5)	72.3 (±18.5)	0.101
Female	65.9 (±24.3)	69.6 (±26.9)	70.0 (±24.7)	0.061	60.9 (±42.2)	64.4 (±41.6)	64.7 (±41.3)	0.514	56.1 (±12.6)	58.4 (±18.6)	61.3 (±19.4)	0.009
p-value †	0.001	0.006	0.002		0.009	0.003	0.001		<0.001	<0.001	<0.001
Race/Color
White	65.1 (±28.5)	71.9 (±26.5)	72.1 (±23.9)	0.004	64.9 (±41.0)	69.5 (±36.3)	71.3 (±38.0)	0.686	57.6 (±20.2)	61.8 (±20.4)	62.8 (±21.0)	0.031
Black	72.0 (±26.4)	69.0 (±26.6)	72.0 (±28.4)	0.932	71.4 (±39.8)	61.9 (±43.8)	66.6 (±44.7)	0.907	62.8 (±20.0)	63.0 (±20.6)	64.1 (±18.8)	0.914
Brown	73.6 (±20.6)	76.7 (±23.7)	77.1 (±23.1)	0.065	67.9 (±39.6)	75.5 (±38.5)	74.5 (±38.0)	0.067	62.8 (±17.5)	64.7 (±19.6)	67.9 (±19.3)	0.003
p-value §	0.283	0.340	0.423		0.707	0.144	0.781		0.317	0.662	0.354
2nd layer – Individuals’ lifestyle
Physical activity/week
0 to 3 days	70.5 (±24.8)	73.1 (±25.1)	75.0 (±24.4)	0.015	66.2 (±40.2)	71.9 (±38.6)	73.7 (±38.1)	0.036	60.6 (±19.8)	62.8 (±20.6)	65.6 (±19.9)	0.003
4 to 7 days	71.6 (±22.0)	79.4 (±24.4)	74.6 (±22.9)	0.016	72.5 (±38.9)	72.5 (±38.8)	67.6 (±41.4)	0.617	63.2 (±13.7)	66.9 (±16.5)	66.8 (±19.7)	0.417
p-value †	0.952	0.144	0.844		0.328	0.957	0.415		0.452	0.249	0.721
Fruit and vegetable consumption/week
0 to 3 days	73.2 (±23.7)	75.5 (±23.3)	76.7 (±23.3)	0.062	70.2 (±38.3)	71.6 (±38.4)	77.3 (±34.9)	0.094	60.7 (±19.2)	63.5 (±20.7)	66.0 (±19.7)	0.014
4 to 7 days	67.9 (±24.6)	72.9 (±26.9)	72.9 (±24.9)	0.018	64.3 (±41.7)	72.5 (±38.8)	76.4 (±42.0)	0.118	61.6 (±18.4)	63.6 (±19.1)	65.7 (±20.0)	0.075
p-value †	0.131	0.658	0.299		0.443	0.800	0.152		0.731	0.964	0.986
Consumption of fried and processed foods/week
0 to 3 days	71.4 (±23.6)	75.4 (±24.2)	77.3 (±23.0)	<0.001	67.6 (±39.8)	71.2 (±38.7)	75.8 (±37.4)	0.073	61.3 (±17.9)	63.7 (±20.0)	66.7 (±19.5)	0.001
4 to 7 days	68.7 (±25.9)	71.0 (±27.1)	68.2 (±25.7)	0.239	66.6 (±40.6)	74.3 (±38.4)	63.8 (±41.1)	0.032	60.6 (±21.1)	63.2 (±19.7)	63.5 (±20.6)	0.340
p-value †	0.582	0.573	0.025		0.870	0.573	0.057		0.900	0.860	0.423
Sun exposure/week
0 to 3 days	72.9 (±23.1)	77.2 (±23.3)	78.4 (±23.1)	0.003	71.5 (±37.6)	75.8 (±37.6)	77.6 (±34.8)	0.180	61.1 (±18.4)	63.9 (±20.1)	68.0 (±18.4)	0.002
4 to 7 days	67.3 (±25.7)	69.6 (±26.9)	69.4 (±24.6)	0.212	60.9 (±42.8)	66.1 (±39.5)	64.7 (±43.1)	0.531	61.1 (±19.5)	63.0 (±19.6)	62.6 (±21.5)	0.312
p-value †	0.164	0.061	0.010		0.134	0.050	0.069		0.841	0.798	0.140
Difficulty sleeping
Yes	65.0 (±25.5)	69.9 (±25.3)	71.3 (±24.4)	0.004	59.5 (±41.8)	63.9 (±41.6)	66.3 (±42.4)	0.290	55.5 (±19.0)	59.4 (±20.7)	62.1 (±20.9)	<0.001
No	77.8 (±20.5)	79.6 (±23.8)	79.3 (±23.0)	0.239	77.0 (±35.4)	82.0 (±31.7)	80.4 (±32.1)	0.345	68.1 (±16.0)	68.7 (±17.7)	70.6 (±17.4)	0.575
p-value †	0.001	0.006	0.016		0.004	0.002	0.038		<0.001	0.002	0.005
Smoking
Yes	78.1 (±19.7)	76.5 (±24.4)	79.6 (±25.8)	0.846	91.6 (±15.4)	87.5 (±17.2)	87.5 (±24.8)	0.819	61.5 (±11.6)	64.5 (±20.1)	67.5 (±18.3)	0.670
No	70.3 (±24.4)	74.1 (±25.1)	74.7 (±24.0)	0.001	66.2 (±40.4)	71.3 (±39.1)	71.9 (±39.1)	0.082	61.1 (±19.1)	63.5 (±19.9)	65.8 (±19.9)	0.002
p-value †	0.449	0.808	0.533		0.104	0.455	0.313		0.964	0.958	0.911
Alcoholism
Yes	73.8 (±23.2)	75.0 (±25.7)	78.3 (±23.4)	0.117	68.7 (±39.7)	75.5 (±37.6)	77.2 (±36.8)	0.069	61.8 (±16.7)	63.8 (±18.8)	67.0 (±19.3)	0.096
No	68.2 (±24.8)	73.7 (±24.5)	72.2 (±24.3)	0.005	66.3 (±40.3)	69.3 (±39.2)	69.0 (±39.9)	0.707	60.6 (±20.3)	63.4 (±20.8)	65.0 (±20.2)	0.011
p-value †	0.129	0.639	0.090		0.702	0.261	0.156		0.836	0.899	0.521
3rd layer – Social and community networks
Number of people residing in the household
Lives alone or one	79.1 (±15.3)	61.1 (±26.1)	72.2 (±23.1)	0.355	59.2 (±49.3)	44.4 (±44.0)	85.1 (±29.3)	0.115	58.2 (±19.7)	62.6 (±23.1)	71.5 (±19.1)	0.008
≥ 2	70.2 (±24.5)	75.0 (±24.8)	75.0 (±24.1)	<0.001	67.8 (±39.5)	73.5 (±37.8)	71.9 (±39.1)	0.116	61.3 (±18.8)	63.6 (±19.8)	65.6 (±19.8)	0.008
p-value †	0.391	0.111	0.597		0.718	0.048	0.288		0.506	0.869	0.391
Lives with people in the at-risk group
Yes	70.8 (±24.2)	75.4 (±24.2)	76.3 (±22.6)	0.005	67.4 (±40.8)	71.8 (±38.0)	74.4 (±39.3)	0.160	60.5 (±17.6)	61.1 (±19.1)	64.7 (±18.4)	0.131
No	70.6 (±24.4)	73.1 (±25.9)	73.4 (±25.4)	0.158	67.4 (±39.2)	72.2 (±39.3)	70.7 (±38.2)	0.397	61.7 (±19.9)	66.1 (±20.5)	67.1 (±21.2)	0.004
p-value †	0.973	0.698	0.608		0.898	0.761	0.394		0.742	0.132	0.295
4th layer – Living conditions
Water supply
Distribution network	70.6 (±24.4)	74.5 (±25.2)	75.6 (±23.9)	<0.001	67.6 (±39.8)	72.8 (±38.1)	74.2 (±38.0)	0.081	61.1 (±19.0)	64.1 (±19.8)	66.2 (±19.9)	<0.001
Other	71.5 (±21.7)	70.4 (±23.2)	63.6 (±24.6)	0.200	63.6 (±43.3)	60.6 (±44.2)	48.4 (±43.1)	0.174	61.8 (±15.4)	54.9 (±19.1)	60.3 (±17.9)	0.417
p-value †	0.976	0.445	0.083		0.672	0.315	0.020		0.969	0.174	0.282
Sewer drain
Sewer system	69.4 (±24.0)	73.1 (±24.7)	75.2 (±23.2)	0.003	65.8 (±39.4)	72.2 (±38.7)	73.0 (±37.2)	0.103	59.8 (±18.6)	61.4 (±19.1)	65.4 (±19.0)	0.002
Other	73.3 (±24.6)	76.6 (±25.6)	74.3 (±25.8)	0.190	70.6 (±41.0)	71.7 (±38.5)	71.7 (±41.8)	0.837	63.7 (±19.0)	68.0 (±20.9)	66.7 (±21.5)	0.100
p-value †	0.269	0.241	0.995		0.239	0.766	0.910		0.221	0.029	0.652
5th Layer – General socioeconomic, cultural and environmental conditions
Family income
< 3 minimum wages	70.5 (±24.4)	74.2 (±25.2)	73.9 (±25.1)	0.007	69.1 (±39.3)	72.8 (±37.7)	73.2 (±38.9)	0.293	61.2 (±19.8)	64.1 (±20.4)	65.3 (±21.0)	0.040
>3 minimum wages	71.0 (±24.1)	74.3 (±24.9)	76.3 (±22.4)	0.117	64.8 (±41.0)	70.8 (±39.9)	71.7 (±38.6)	0.404	61.0 (±17.2)	62.7 (±19.1)	66.7 (±17.9)	0.025
p-value †	0.918	0.939	0.718		0.551	0.818	0.637		0.984	0.637	0.776

location_on

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[T1FN1] Legend: *Friedman Test/

[T1FN2] ^§Kruskal-Wallis/

[T1FN3] ^†Mann-Whitney.