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However, the COVID-19 pandemic exposed significant barriers to healthcare access among vulnerable groups, particularly due to the intersection of multiple vulnerabilities. This study aimed to examine how intersectionality\u2014specifically sex\/gender, race\/ethnicity, and education level\u2014has influenced inequalities in healthcare service utilization among vulnerable populations during the COVID-19 pandemic in Brazil. Methods: This cross-sectional study is part of the \u201cCOVID-19 Social Thermometer in Brazil\u201d project, conducted between May 2022 and October 2023 in Brazil\u2019s state capitals and the Federal District, focusing on populations considered socially vulnerable during the pandemic. Participants were selected using sequential sampling and completed a structured questionnaire. Statistical analyses\u2014performed using Excel, RStudio (version 4.3.2), and ArcGIS\u2014included sociodemographic profiling, the construction of the Jeopardy Index (a measure of social vulnerability), and binary logistic regression to explore associations between Jeopardy Index and healthcare service utilization. Results: 3406 participants, the majority were men (60%), aged 30 to 59 years (65.1%), and identified as Black or Brown (72.2%). Most participants were concentrated in the Northeast (26.6%) and North (22.3%) macroregions. A high reliance on public healthcare services (SUS) was observed, particularly in the Southeast (96%). According to the Jeopardy Index, the most socially vulnerable groups\u2014such as women, transgender individuals, Black people, and those with no formal education\u2014were significantly more likely to rely on SUS (OR = 3.14; 95% CI: 1.34\u20137.35) and less likely to use private healthcare (OR = 0.07; 95% CI: 0.02\u20130.20), reflecting a 214% higher likelihood of SUS use and a 93% lower likelihood of private service utilization compared to the most privileged group. Conclusions: Our findings reveal that individuals experiencing intersecting social vulnerabilities face marked inequalities in healthcare access. Without SUS, these populations would likely have been excluded from essential care. Strengthening SUS and implementing inclusive public policies are critical to reducing disparities and ensuring equitable healthcare access for historically marginalized groups.<\/jats:p>","DOI":"10.3390\/ijerph22060831","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T20:39:36Z","timestamp":1748205576000},"page":"831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Disparities in Healthcare Utilization Among Vulnerable Populations During the COVID-19 Pandemic in Brazil: An Intersectional Analysis"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-8155","authenticated-orcid":false,"given":"Let\u00edcia Perticarrara","family":"Ferezin","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rander Junior","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7654-2402","authenticated-orcid":false,"given":"Heriederson S\u00e1vio Dias","family":"Moura","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-9216","authenticated-orcid":false,"given":"M\u00f4nica Chiodi Toscano","family":"de Campos","sequence":"additional","affiliation":[{"name":"Department of Nursing, School of Health Sciences, University of Bras\u00edlia, Bras\u00edlia 70910-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3562-3246","authenticated-orcid":false,"given":"Felipe Mendes","family":"Delpino","sequence":"additional","affiliation":[{"name":"Graduate Program in Dentistry, Federal University of Pelotas, Pelotas 96010-610, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3436-2654","authenticated-orcid":false,"given":"Murilo C\u00e9sar do","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Graduate Program in Nursing, Nursing School, Federal University of Alfenas, Alfenas 37130-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1659-8321","authenticated-orcid":false,"given":"Juliana Soares Ten\u00f3rio de","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ione Carvalho","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4792-8714","authenticated-orcid":false,"given":"Ricardo Alexandre","family":"Arc\u00eancio","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Nursing and Public Health, School of Nursing, University of S\u00e3o Paulo at Ribeir\u00e3o Preto, S\u00e3o Paulo 05508-220, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,25]]},"reference":[{"key":"ref_1","first-page":"qxad014","article-title":"Social determinants of health in Brazil during the COVID-19 pandemic: Strengths and limitations of emergency responses","volume":"1","author":"Lazzari","year":"2023","journal-title":"Health Aff. 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