Johrdy Amilton da Costa Braga, Maria Natália Cardoso, Yandra Alves Prestes, Jaqueline Gabriela da Silva Frota, Hércules Lázaro Morais Campos, Elisa Brosina de Leon, Rafael Martins da Costa

Abstract

Introduction: social determinants shape health outcomes and perceptions, particularly in rural and remote settings. In the Brazilian Amazon, geographic isolation and socioeconomic vulnerability may influence how individuals with type 2 diabetes mellitus (T2DM) perceive their health.

Objective: to identify clusters of social determinants (SDoH) and examine their association with self-perceived health among adults with T2DM living in rural Brazilian Amazon.

Methods: a cross-sectional analysis was conducted using data from 756 adults with T2DM enrolled in the Health Study in Primary Care of the Amazonian Population (SAPPA) between 2020 and 2022 across 10 cities in the Brazilian Amazon. Self-perceived health was assessed using three measures: current self-perception, comparison with peers of the same age, and comparison with the previous year. Social determinants variables included sex, age group, race, marital status, education, employment, retirement status, and income. Latent class analysis identified clusters of social determinants. Multinomial logistic regression models examined associations between social determinant classes and self-perceived health, while adjusting for diabetes duration, number of comorbidities, smoking, and alcohol consumption.

Results: overall, 59.1% of participants reported negative self-perceived health. Four social determinants classes were identified, each representing a distinct profile of social vulnerability. No significant associations were observed between SDoH classes and current or previous-year self-perception. However, individuals in two classes characterized by younger age profiles (Classes 3 and 4) were less likely to report negative self-perceived health to peers of the same age (adjusted OR=0.49; 95% CI: 0.30–0.80 and adjusted OR=0.58; 95% CI: 0.36–0.96, respectively) when compared with the reference class of older, predominantly retired men.

Conclusion: distinct clusters of social determinants were identified among adults with T2DM in the rural Brazilian Amazon. Although most SDoH profiles were not directly associated with overall self-perceived health, age-related social configurations influenced comparative self-perception. These findings highlight the importance of context-sensitive approaches in rural primary care and support the development of targeted strategies addressing social vulnerability in remote Brazilian Amazonian settings.

Keywords: Vulnerable population, Diabetes Mellitus, Type 2, Health Status Disparities, Aging.

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