ArticlePloS one2026
Geographical barriers and multimorbidity in quilombola territories of the amazon region.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Biosociodemographic, Anthropometric, and Laboratory Profiles Associated with the Risk of Developing Chronic Kidney Disease Among Older Adults Living in Quilombola Communities: A Cross-sectional Study.Journal of immigrant and minority health · 2026Article
- Article
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13 authors.
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Abstract
backgroundQuilombola communities in the Brazilian Amazon face persistent social and territorial inequities that shape health outcomes and access to care. Geographic isolation, limited transportation, centralization of specialized services, and socioeconomic disadvantages contribute to unequal opportunities for timely diagnosis and treatment. Understanding how these determinants interact with patterns of multimorbidity is essential for guiding equiTable health policies and strengthening primary care in remote territories.
methodsA cross-sectional epidemiological study was conducted with 518 adults from nine quilombola communities in Santarém, Pará. Data were collected through household surveys addressing sociodemographics, self-reported diseases, service utilization and resolvability. Geographic coordinates of communities and health services were mapped to classify accessibility as high, medium or low. Diseases were converted into a binary matrix to estimate prevalence and identify multimorbidity (≥2 conditions). Statistical analyses included chi-square tests, ANOVA, Spearman correlations and heatmap visualization. A Composite Access Index (CAI) integrating geographic distance, epidemiological burden and service-use indicators was developed. A Random Forest model was used to identify conditions most strongly associated with multimorbidity.
resultsCommunities showed marked territorial heterogeneity. Pérola do Maicá had the highest accessibility, while Ituqui, Tiningu and Murumuru presented substantial geographic and logistical barriers. Service utilization ranged from 42.9% to 95.0%, and most communities relied on care outside their territory (70-95%). Complete problem resolution was reported by 72.5% of participants, though with variation among communities. The CAI identified Ituqui (0.550), Tiningu (0.480) and Murumurutuba (0.331) as the most vulnerable territories. The Random Forest model achieved 93.6% accuracy, with hypertension, diabetes, musculoskeletal diseases, arthritis/rheumatism and heart disease emerging as key predictors of multimorbidity. DISCUSSION: Findings indicate that social and territorial determinants are strongly associated with inequities in access to health services, continuity of care, and disease burden across quilombola communities.
conclusionsGeographic barriers and the distribution of health services are associated with distinct patterns of multimorbidity and health service access among quilombola populations. Strengthening primary care, transportation, and diagnostic support may help mitigate inequities and improve health conditions in remote Amazonian territories.
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