Spatial and multilevel determinants of delayed healthcare access following occupational accidents in Brazil

BACKGROUND: 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. METHODS: 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. RESULTS: 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 = 1.11; 95% CI: 1.06-1.15) and Brown individuals (AOR = 1.13; 95% CI: 1.10-1.16) had higher odds of Delayed healthcare-seeking. Agricultural workers were more likely to delay care (AOR = 1.20; 95% CI: 1.14-1.25). Injuries occurring in the evening showed the strongest association with delay (AOR = 3.62; 95% CI: 3.51-3.75). Higher odds of delay were also observed among individuals with lower limb injuries (AOR = 1.51), trunk/back injuries (AOR = 2.05), and multiple injuries (AOR = 1.90). Living in municipalities with lower health facility density was associated with an increased likelihood of Delayed healthcare-seeking. CONCLUSIONS: 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.