Evidence map›Paper›PMID 41219690›Full record

ArticleBMC public health2025

Unequal access in a universal health system: COVID-19 vaccination and health services utilization among international migrants in Brazil.

Juliana Soares Tenório De Araújo, Letícia Perticarrara Ferezin, Heriederson Sávio Dias Moura, Rander Junior Rosa, Ariela Fehr Tártaro, Ione Carvalho Pinto, Mônica Chiodi Toscano de Campos, Ricardo Alexandre Arcêncio

Abstract read
In one paragraph

Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Juliana Soares Tenório De Araújo *University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.
Letícia Perticarrara Ferezin *University of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil. lehferezin@usp.br.
Heriederson Sávio Dias MouraUniversity of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.
Rander Junior RosaUniversity of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.
Ariela Fehr TártaroUniversity of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.
Ione Carvalho PintoUniversity of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.
Mônica Chiodi Toscano de CamposUniversity of Brasília, Brasília, Brazil.
Ricardo Alexandre ArcêncioUniversity of São Paulo at Ribeirão Preto School of Nursing, São Paulo, 14040-902, Brazil.

Funding

Conselho Nacional de Desenvolvimento Científico e Tecnológico 307014/2022-3Coordenação de Aperfeiçoamento de Pessoal de Nível Superior 88887.657730/2021-00Fundação de Amparo à Pesquisa do Estado de São Paulo 2021/08263-7
6 · The paper itself

Abstract

backgroundThe COVID-19 pandemic has intensified existing health inequities, particularly among international migrants, who often face barriers to healthcare access and vaccination. In Brazil, where the Unified Health System (SUS) provides universal coverage, little is known about COVID-19 vaccination coverage and healthcare utilization among international migrants. This study aimed to analyze COVID-19 vaccination coverage, associated factors, and the use of SUS services among international migrants in Brazil during the pandemic. 

methodsA cross-sectional study was conducted through face-to-face interviews with 374 international migrants residing in Brazil for at least six months. Participants were recruited between May 2022 and October 2023 through community networks and organizations in 26 of Brazil's 27 federative units. COVID-19 vaccines were provided exclusively through SUS infrastructure and facilities. Data were collected via face-to-face interviews using a culturally adapted questionnaire covering sociodemographic characteristics, vaccination status, healthcare utilization, and trust in health services. Descriptive statistics and binary logistic regression were used to identify factors associated with COVID-19 vaccination and SUS utilization. Analyses were conducted using RStudio software.

resultsAmong participants, 82.4% reported receiving a COVID-19 vaccine, and 93.0% reported using SUS services during the pandemic. Lower likelihood of vaccination was observed among migrants who identified as White (adjusted odds ratio [aOR]: 0.42; 95% CI: 0.21-0.89) and those with completed elementary education (aOR: 0.39; 95% CI: 0.19-0.86). Migrants living with older adults (aOR: 2.54; 95% CI: 1.12-6.64) and those tested for COVID-19 prior to vaccination (aOR: 3.67; 95% CI: 2.00-6.96) were more likely to be vaccinated. Increased utilization of the SUS was positively associated with trust in hospitals and healthcare professionals (aOR: 3.22; 95% CI: 1.25-8.89), while higher educational attainment (aOR: 0.24; 95% CI: 0.06-1.09) and residing in the Northeast (adjusted OR: 0.31; 95% CI: 0.09-0.99; p = 0.047) were associated with lower utilization of the SUS.

conclusionsInternational migrants in Brazil experienced significant barriers to COVID-19 vaccination and healthcare access, influenced by race, education, household composition, and trust in health institutions. These findings reveal critical gaps in universal health coverage during pandemics and highlight the need for targeted, culturally sensitive public health strategies to promote equity in vaccination and healthcare delivery for migrant populations.

Indexed as

COVID-19COVID-19 VaccinesHealthcare DisparitiesHealth Services AccessibilityPatient Acceptance of Health CareTransients and MigrantsVaccinationVaccination CoverageAdultBrazilCross-Sectional StudiesFemaleHumansMaleMiddle AgedSARS-CoV-2COVID-19 VaccinesBrazilCOVID-19MigrantsUnified health systemVaccination

Identifiers

PMID41219690
PMCPMC12607137

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.