Racial disparities in glucose sensor and insulin pump use and formal access through Brazil's Unified health system among people with type 1 diabetes: a cross-sectional study.
Abstract
Aims
To evaluate racial disparities in glucose sensor and insulin pump use among people with type 1 diabetes in Brazil and associations of race/skin color with formal requests and approvals through the Brazilian Unified Health System (SUS).
Methods
This cross-sectional study included 2454 adults with type 1 diabetes or caregivers of children and adolescents. Multivariable logistic regression examined race/skin color associations with technology use, formal requests, and approvals. Minimally and fully adjusted models were compared, and nonlinear Oaxaca-Blinder decomposition quantified explained and unexplained technology-use gaps.
Results
Compared with White participants, Brown participants had lower odds of sensor use (OR 0.76; 95% CI 0.62-0.94) and pump use (OR 0.75; 95% CI 0.59-0.94); corresponding estimates for Black participants were 0.57 (0.39-0.82) and 0.53 (0.32-0.84). Race/skin color was not significantly associated with formal requests or approvals, whereas geographic region was strongly associated with approval. Measured sociodemographic characteristics explained 27.7%-52.9% of racial technology-use gaps.
Conclusions
Racial disparities in technology use persisted beyond measured socioeconomic differences. Contrasting patterns across current use and formal SUS outcomes suggest that inequities may arise at other stages of access.