AccScience Publishing / IJPS / Volume 9 / Issue 2 / DOI: 10.36922/ijps.0865
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“I can’t breathe”: The effect of intersectionality on access to COVID-19 diagnostic tests in Brazil

Juçara Cezario da Silva1† Ricardo de Mattos Russo Rafael2†* Dandara Costa Alcântara2 Caroline Moraes Soares Motta de Carvalho3 Max Fellipe Cezario Porphirio4 Mayara Christinne Cezario Porphirio5 Mercedes Neto2 Tiago Braga do Espírito Santo6
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1 Municipal Secretary of Health, Rio de Janeiro, 20211-110, Brazil
2 Department of Public Health, College of Nursing, State University of Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
3 Regional Nursing Council of Rio de Janeiro, Rio de Janeiro, 20071-000, Brazil
4 South-South Exchange Program for Research on the History of Development, Rio de Janeiro/Amsterdam, 22250-020, Brazil/Netherlands
5 Center for Assistance and Research in Eating Disorders, Institute of Nutrition, University of Rio de Janeiro State, Rio de Janeiro, 20550-170, Brazil
6 Department of Medical-Surgical Nursing, State University of Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
IJPS 2023, 9(2), 26–36;
Submitted: 27 April 2023 | Accepted: 14 July 2023 | Published: 28 July 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( )

This research aimed to analyze the effect of intersectionality on patients’ access to COVID-19 diagnostic tests during the outbreak of severe acute respiratory syndrome (SARS) in Brazil. A cross-sectional study was conducted, utilizing a secondary analysis of Brazilian patient records from March to June 2020. The first 4 months of the COVID-19 epidemic were selected as this was the period during which countries organized themselves to provide care for COVID-19 patients. Crude and adjusted odds ratios (OR) were calculated using logistic regression. Interactions with education were tested, considering it a proxy for social class. Statistical analysis was performed using Stata SE 15 software. Out of the 179,295 records examined, 6,326 (3.53%) patients were not tested, and 4,512 (71.32%) of the untested patients were black. The odds of not being tested were higher for black males (OR: 2.30) and black females (OR: 2.58) compared to other racial and gender groups. Black males exhibited a higher likelihood of non-testing than black females, while black females had a higher likelihood than both white males and females. Race, when modulated by social class, showed significant effects on failure to perform diagnostic testing in patients with SARS. The results suggest that structural racism, gender, and social class inequalities significantly impact access to diagnostic testing. Therefore, it is necessary for public policies to consider these findings to address not only the symptoms but also the underlying causes of racism within the social structure.

Gender and health
Ethnic groups
Social class
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil ([Coordination for the Improvement of Higher Education Personnel - Brazil] CAPES)
Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ)
Brazilian Research Council (National Council for Scientific and Technological Development - CNPq)
University of Rio de Janeiro State (Program for Incentives to Scientific, Technical and Artistic Production of the Rio de Janeiro State University - PROCIENCIA/UERJ)

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Conflict of interest
The authors declare they have no competing interests.
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