{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:41:26Z","timestamp":1792777286583,"version":"4.5.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed healthcare-seeking following occupational accidents increases the risk of complications, disability, and mortality. Although occupational injuries remain a major public health concern in Brazil, national evidence on the spatial distribution and multilevel determinants of Delayed healthcare-seeking is limited. This study aimed to assess the prevalence, geographic distribution, and individual and municipal-level determinants of Delayed healthcare-seeking following occupational accidents in Brazil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide cross-sectional study was conducted using 2024 data from the Brazilian Notifiable Diseases Information System. A total of 477,276 Occupational accident cases were included in the analysis. Delayed healthcare-seeking was defined as accessing healthcare services more than 24 hours after injury occurrence. A two-level mixed-effects logistic regression model was used to identify individual and municipal-level determinants, while spatial clustering techniques were applied to assess spatial clustering patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of Delayed healthcare-seeking was 12.2%. Significant spatial clustering was observed across Brazilian municipalities, with hotspots concentrated in the North and Midwest regions. Compared with White individuals, Black (AOR\u2009=\u20091.11; 95% CI: 1.06\u20131.15) and Brown individuals (AOR\u2009=\u20091.13; 95% CI: 1.10\u20131.16) had higher odds of Delayed healthcare-seeking. Agricultural workers were more likely to delay care (AOR\u2009=\u20091.20; 95% CI: 1.14\u20131.25). Injuries occurring in the evening showed the strongest association with delay (AOR\u2009=\u20093.62; 95% CI: 3.51\u20133.75). Higher odds of delay were also observed among individuals with lower limb injuries (AOR\u2009=\u20091.51), trunk\/back injuries (AOR\u2009=\u20092.05), and multiple injuries (AOR\u2009=\u20091.90). Living in municipalities with lower health facility density was associated with an increased likelihood of Delayed healthcare-seeking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More than one in ten workers in Brazil experience Delayed healthcare-seeking following occupational injuries. Delays are associated with both social vulnerability and structural inequalities in healthcare access and exhibit significant geographic clustering. Strengthening healthcare accessibility, extending service availability, and implementing geographically targeted interventions in high-risk municipalities may improve timely care and reduce adverse occupational health outcomes. Findings highlight urgent need for geographically targeted occupational health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360805","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:30:22Z","timestamp":1792776622000},"page":"e0360805","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial and multilevel determinants of delayed healthcare access following occupational accidents in Brazil"],"prefix":"10.1371","volume":"21","author":[{"given":"Ahmed","family":"Fentaw Ahmed","sequence":"first","affiliation":[{"name":"College of Medicine and Health Sciences, Injibara University","place":["Injibara, Ethiopia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everton Nunes","family":"da Silva","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia","place":["Bras\u00edlia, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josivania Silva","family":"Farias","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia","place":["Bras\u00edlia, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Valeria Machado","family":"Mendon\u00e7a","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia","place":["Bras\u00edlia, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia Fernandes","family":"de Andrade","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia","place":["Bras\u00edlia, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-9449","authenticated-orcid":true,"given":"Megbaru","family":"Debalkie Animut","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Injibara University","place":["Injibara, Ethiopia"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Resende","family":"Nogueira Cruvinel","sequence":"additional","affiliation":[{"name":"University of Bras\u00edlia","place":["Bras\u00edlia, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"pone.0360805.ref001","unstructured":"Organization IL. ILO Helpdesk: Business, Occupational Safety and Health. 2024."},{"key":"pone.0360805.ref002","year":"2024"},{"issue":"2","key":"pone.0360805.ref003","doi-asserted-by":"crossref","first-page":"4","DOI":"10.20517\/ohir.2023.49","article-title":"Epidemiological survey of accidents with venomous animals treated at the Regional Hospital of Bom Jesus, Piau\u00ed, Northeast Brazil","volume":"4","author":"GD dos Santos Silva","year":"2024","journal-title":"One Health Implement Res"},{"issue":"13","key":"pone.0360805.ref004","doi-asserted-by":"crossref","DOI":"10.54033\/cadpedv21n13-246","article-title":"Analysis of occupational accident profiles in mining activities in the state of Esp\u00edrito Santo, Brazil","volume":"21","author":"RF Faria","year":"2024","journal-title":"Cad Pedag\u00f3gico"},{"key":"pone.0360805.ref005","doi-asserted-by":"crossref","first-page":"100798","DOI":"10.1016\/j.clinsp.2025.100798","article-title":"Fatal occupational accidents in Brazil: A national case-control study using 2023 data","volume":"80","author":"CS Andersen","year":"2025","journal-title":"Clinics (Sao Paulo)"},{"issue":"14","key":"pone.0360805.ref006","doi-asserted-by":"crossref","DOI":"10.53843\/bms.v10i14.1087","article-title":"Exposi\u00e7\u00e3o ocupacional a materiais biol\u00f3gicos: Um estudo com residentes m\u00e9dicos no brasil","volume":"10","author":"AJ Ferreira Serafim","year":"2025","journal-title":"BMS"},{"issue":"8","key":"pone.0360805.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000657","article-title":"Three delays model applied to pediatric injury care seeking in Northern Tanzania: A mixed methods study","volume":"2","author":"EM Keating","year":"2022","journal-title":"PLOS Glob Public Health"},{"issue":"5","key":"pone.0360805.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0318288","article-title":"Occupational profile and prevalence of workplace accidents among beach workers","volume":"20","author":"C Cremonese","year":"2025","journal-title":"PLoS One"},{"key":"pone.0360805.ref009","article-title":"Occupational patterns and risks of occupational accidents with biological material: A cross-sectional study, Brazil, 2015-2019","volume":"34","author":"A \u00cdndio do Brasil J de","year":"2025","journal-title":"Epidemiol Serv Saude"},{"issue":"4","key":"pone.0360805.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0320149","article-title":"Delays in seeking healthcare and its determinants among malaria patients in Ethiopia: A systematic review and meta-analysis","volume":"20","author":"M Tadesse Abebe","year":"2025","journal-title":"PLoS One"},{"key":"pone.0360805.ref011","doi-asserted-by":"crossref","first-page":"191","DOI":"10.2147\/RMHP.S445001","article-title":"Healthcare-seeking delays in acute ischemic stroke patients: The influence of gender, immigrant status, and educational background","volume":"17","author":"Y Jiang","year":"2024","journal-title":"Risk Manag Healthc Policy"},{"issue":"1","key":"pone.0360805.ref012","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1186\/s12884-025-07968-4","article-title":"Delays in the decision to seek care and associated factors among women in Ethiopia: Systematic review and meta-analysis","volume":"25","author":"TS Hadaro","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0360805.ref013","article-title":"Temporal trends in occupational mortality in Brazil, 2010-2019","volume":"21","author":"ALM Feitosa","year":"2024","journal-title":"Revista Brasileira de Medicina do Trabalho"},{"issue":"1","key":"pone.0360805.ref014","article-title":"Spatiotemporal patterns and structural inequalities associated with the incidence of common workplace accidents in Brazil","volume":"23","author":"CJ Dos Santos J\u00fanior","year":"2025","journal-title":"Rev Bras Med Trab"},{"issue":"2","key":"pone.0360805.ref015","article-title":"Epidemiological study in Brazil: Scorpion sting cases in Natal, Rio Grande do Norte","volume":"10","author":"KAM Ara\u00fajo","year":"2024","journal-title":"Heliyon"},{"issue":"3","key":"pone.0360805.ref016","article-title":"Work accidents registered in the Brazilian social security system between 2016 and 2020: A descriptive analysis","volume":"22","author":"DO de Barros","year":"2024","journal-title":"Rev Bras Med Trab"},{"issue":"4","key":"pone.0360805.ref017","article-title":"Occupational accident fatalities in Brazil: A time series study from 2011 to 2021","volume":"20","author":"REDA Paiva","year":"2025","journal-title":"PLoS One"},{"issue":"6","key":"pone.0360805.ref018","doi-asserted-by":"crossref","first-page":"831","DOI":"10.3390\/ijerph22060831","article-title":"Disparities in healthcare utilization among vulnerable populations during the COVID-19 pandemic in Brazil: An intersectional analysis","volume":"22","author":"LP Ferezin","year":"2025","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0360805.ref019","article-title":"Notifiable Diseases Information System (SINAN): Main features of tuberculosis notification and data analysis","volume":"29","author":"MS Rocha","year":"2020","journal-title":"Epidemiol Serv Saude"},{"key":"pone.0360805.ref020","unstructured":"Pouramin P, Li S, Busse JW, Sprague S, Devereaux P, Jagnoor J. Delays to hospital admission in 31,255 fracture patients across 18 low-middle income countries: A prospective, observational study. 2020;8(5):e711."},{"key":"pone.0360805.ref021","author":"WHO","year":"2019"},{"issue":"5","key":"pone.0360805.ref022","article-title":"Neighbourhood socioeconomic position and risks of major chronic diseases and all-cause mortality: A quasi-experimental study","volume":"8","author":"D Kim","year":"2018","journal-title":"BMJ Open"},{"key":"pone.0360805.ref023","doi-asserted-by":"crossref","first-page":"1389932","DOI":"10.3389\/frph.2025.1389932","article-title":"Spatial distribution and determinants of children ever born among reproductive age women in Ethiopia: Spatial and multilevel analysis of 2019 mini Ethiopian demographic health survey","volume":"7","author":"AF Ahmed","year":"2025","journal-title":"Front Reprod Health"},{"issue":"1","key":"pone.0360805.ref024","doi-asserted-by":"crossref","first-page":"31053","DOI":"10.1038\/s41598-025-15720-3","article-title":"Spatial distribution and determinants of full package maternal health service utilization in Ethiopia using 2019 Mini Ethiopian Demographic Health Survey","volume":"15","author":"AF Ahmed","year":"2025","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0360805.ref025","first-page":"209","article-title":"Mudan\u00e7as Ambientais e Sa\u00fade P\u00fablica: Observa\u00e7\u00f5es sobre a trajet\u00f3ria de uma fronteira agr\u00edcola amaz\u00f4nica","volume":"4","author":"ML Weihs","year":"2015","journal-title":"Technological, Science E"},{"issue":"6","key":"pone.0360805.ref026","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1007\/s00590-021-03080-3","article-title":"Barriers to trauma care in South and Central America: A systematic review","volume":"32","author":"F Kinder","year":"2022","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"6","key":"pone.0360805.ref027","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-070900","article-title":"Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi","volume":"13","author":"J Whitaker","year":"2023","journal-title":"BMJ Open"},{"key":"pone.0360805.ref028","doi-asserted-by":"crossref","first-page":"100658","DOI":"10.1016\/j.jth.2019.100658","article-title":"Understanding how low-income communities gain access to healthcare services: A qualitative study in S\u00e3o Paulo, Brazil","volume":"15","author":"T Guimar\u00e3es","year":"2019","journal-title":"Journal of Transport & Health"},{"key":"pone.0360805.ref029","article-title":"Factors associated with poor access to health services in Brazil","volume":"24","author":"MNP Dantas","year":"2020","journal-title":"Rev Bras Epidemiol"},{"key":"pone.0360805.ref030","doi-asserted-by":"crossref","unstructured":"Oliveira LGF, Fracolli LA, Ara\u00fajo SS, Gryschek AL d FPL, Silva GL, Lico FMdC. Acesso e uso equitativo dos servi\u00e7os de sa\u00fade: Um desafio para a promo\u00e7\u00e3o da universaliza\u00e7\u00e3o em sa\u00fade. 2023.","DOI":"10.51795\/9786526505793113125"},{"issue":"1","key":"pone.0360805.ref031","first-page":"1573","article-title":"Racial inequalities in access to healthcare services in Brazil: A decomposition analysis","volume":"25","author":"R Coelho","year":"2025","journal-title":"Journal Title Abbreviation"},{"issue":"2","key":"pone.0360805.ref032","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3390\/nursrep16020051","article-title":"Sociodemographic drivers of delays in seeking medical care in the all of us cohort","volume":"16","author":"TM Abegaz","year":"2026","journal-title":"Nurs Rep"},{"key":"pone.0360805.ref033","doi-asserted-by":"crossref","first-page":"1555926","DOI":"10.3389\/fmed.2025.1555926","article-title":"Delayed medical consultation and influencing factors in elderly patients with obstructive sleep apnea syndrome","volume":"12","author":"Q Sun","year":"2025","journal-title":"Front Med (Lausanne)"},{"issue":"3","key":"pone.0360805.ref034","article-title":"Delays in seeking and reaching care for injured patients in four low-income and middle-income countries: A cohort study","volume":"11","author":"Equi-Injury Group","year":"2026","journal-title":"BMJ Glob Health"},{"issue":"2","key":"pone.0360805.ref035","article-title":"Acesso e acessibilidade na aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade no Brasil","volume":"11","author":"ECC Pinho","year":"2020","journal-title":"revenf"},{"issue":"10195","key":"pone.0360805.ref036","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0140-6736(19)31243-7","article-title":"Brazil\u2019s unified health system: The first 30 years and prospects for the future","volume":"394","author":"MC Castro","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"pone.0360805.ref037","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s44197-025-00420-y","article-title":"Unintentional injuries requiring medical attention in low-income and middle-income countries: Evidence from Nationally Representative surveys in 12 Countries","volume":"15","author":"L Ghalichi","year":"2025","journal-title":"J Epidemiol Glob Health"},{"issue":"5","key":"pone.0360805.ref038","first-page":"1019","article-title":"Pre-hospital care to trauma patients in Addis Ababa, Ethiopia: Hospital-based cross-sectional study","volume":"31","author":"T G\/Ananya","year":"2021","journal-title":"Ethiop J Health Sci"},{"issue":"5","key":"pone.0360805.ref039","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(20)30067-X","article-title":"Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): A prospective observational study","volume":"8","author":"P Pouramin","year":"2020","journal-title":"Lancet Glob Health"},{"issue":"10","key":"pone.0360805.ref040","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2106\/JBJS.18.00516","article-title":"Risk factors for delayed presentation among patients with musculoskeletal injuries in Malawi","volume":"101","author":"KJ Agarwal-Harding","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0360805.ref041","unstructured":"Khan SK, Khanna A, Al-Salahi M, Parker MJ. Does the place of fall influence the time to specialist treatment in patients sustaining hip fractures? A study of 4917 patients falling in four different settings."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360805","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:30:29Z","timestamp":1792776629000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360805"}},"subtitle":[],"editor":[{"given":"Marianne","family":"Clemence","sequence":"first","affiliation":[{"name":"Public Library of Science","place":["UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360805","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}