Racial health disparities: a population-based analysis of physical activity and diabetes-related complications in Brazil

Background: Physical activity plays a protective role in health, however, its distribution may vary depending on social determinants of health. Concurrently, racial disparity in physical activity among people with diabetes Brazil remains scarcely investigated.

Purpose: We aimed to examine the association between physical activity and diabetes-related complications according to race in the Brazilian population.

Methods: We analyzed cross-sectional data from the 2019 National Health Survey, a comprehensive population-based survey of Brazilian adults. Our assessment of physical activity encompassed commuting, leisure, domestic, and occupational activities, which collected through self-reported questionnaires. Diabetes-related complications included impairments in vision, kidney, and circulation, as well as foot ulcers, diabetic coma, and all-cause complications. To assess the association between physical activity and diabetes-related complications, we employed robust Poisson regression models with restricted cubic splines.

Results: Our study involved 2,529 adults with diabetes (48.9% women; mean age: 53.5±11.9 years), with one-third experiencing complications. Black adults engaged less in leisure but more in occupational and commuting physical activity compared to whites. Blacks had higher risks of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) irrespective of physical activity levels. Leisure-time activity reduced all-cause complications (PR: 0.78; 0.71, 0.86), while commuting and occupational activity showed no significant associations. Inactive browns had higher risks of kidney, circulatory, vision, and all-cause complications than active whites, but physical activity attenuated these risks.

Conclusions: Our study unveils that the relationship between physical activity and diabetes-related complications is specific to activity domains and highlights racial disparities in physical activity among individuals with diabetes in Brazil.

Practical implications: Culturally sensitive interventions are crucial to address racial disparities in physical activity and diabetes-related complications in Brazil. Healthcare strategies should consider the diverse needs of racial groups for effective diabetes management.

Funding: CAPES, FAPERGS, and IATS-HCPA/UFRGS (Brazil).