Table 2 Summary of included articles
From: Health disparities among indigenous populations in Latin America: a scoping review
Study ID | Study Design | Country | Years | Number of Subjects | Disease or health outcome | Definition of Ethnic ID | Main findings |
|---|---|---|---|---|---|---|---|
Alarcón 2018 | Cross-Sectional Study | Chile | 2016–2017 | 558 | HIV/AIDS | Surname-based and self-identification | Mapuche patients were generally younger, more likely to be heterosexual, and had lower educational and income levels compared to non-Mapuche patients. Additionally, they had lower median CD4(+) lymphocyte counts, indicating more advanced disease at the time of diagnosis. Specifically, Mapuche patients had a median CD4(+) count of 226 cells/mm³ (CI: 147.1–281.6), compared to 233 cells/mm³ (CI: 203–274.8) in non-Mapuche patients. |
Alvear-Vega 2022 | Cross-Sectional Study | Chile | 2017 | 1,270,485 | Malnutrition | Self-identification | The study observed that Indigenous children had a higher likelihood of experiencing both undernutrition and overnutrition. The relative risk ratio (RRR) for overnutrition was 1.17 (95% CI: 1.15–1.19), while the RRR for undernutrition was 1.09 (95% CI: 1.07–1.13). |
Argoty-Pantoja 2021 | Cohort Study | Mexico | 2020 | 424,637 | COVID-19 | Language-based | The crude COVID-19 fatality rate was 64.8% higher in the Indigenous population compared to the non-Indigenous population, with a fatality rate of 29.97 per 1000 person-weeks for Indigenous individuals versus 18.18 for non-Indigenous individuals. Indigenous outpatients faced a significantly higher risk of death (HR = 1.63, 95% CI: 1.34–1.98) compared to non-Indigenous outpatients. The highest disparities were observed in the South Pacific region (HR = 2.35, 95% CI: 1.49–3.69) and in a subgroup of 13 states (HR = 1.66, 95% CI: 1.33–2.07). |
Balda 2020 | Cohort Study | Ecuador | 2012–2016 | 6,334 | Heart failure | Not specified | This study identified significant predictors of decreased heart failure (HF) mortality, including belonging to Native American or mixed-race populations. Native American ethnicity was associated with a lower mortality rate (β = 0.45, p < 0.01), while individuals of mixed race also exhibited a reduced mortality rate (β = 0.15, p = 0.01). These findings suggest that racial and ethnic factors may influence HF mortality rates. |
Batis 2020 | Cross-Sectional Study | Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, Uruguay). | 2005–2018 | 73,620 | Malnutrition: overweight, obesity, stunting, and anemia (when available) | Self-identifications for Bolivia, Brazil, Ecuador, Colombia, Chile, Guatemala and language-based for Mexico and Peru. | Indigenous populations consistently exhibited higher prevalence of stunting/short stature and anemia across all age groups compared to non-indigenous populations. On average, indigenous populations had 19% points higher stunting/short stature and 6.7% points higher anemia prevalence than non-indigenous groups. The relationship between ethnicity and overweight/obesity was inconsistent. In some countries, indigenous populations had a higher prevalence, while in others, non-indigenous populations had higher rates |
Cabrera 2022 | Cohort Study | Chile | 2012–2019 | 912 | Chronic lymphocytic leuke- mia (CLL) | Surname-based | The incidence of Chronic Lymphocytic Leukemia (CLL) in the general Chilean population was 1.17 per 100,000 person-years, significantly higher than the 0.09 per 100,000 person-years observed in the Chilean Amerindian population. The 5-year overall survival (OS) rate for Chilean Amerindian patients was 29% (95% CI: 1–69%), compared to 57% (95% CI: 52–61%) in non-Amerindian Chilean patients, though this difference was not statistically significant (p = 0.28). |
Cardoso 2023 | Cohort Study | Brazil | 2020–2022 | 2,459,844 | COVID-19 | Self-identification | Indigenous patients had significantly higher hospital mortality rates compared to White patients. In 2020, the odds of death for Indigenous patients were 1.99 (95% CI: 1.59–2.48) compared to White patients. Those using the public health system had an OR of 1.68 (95% CI: 1.42–1.97), while ICU admission increased the risk by 47% (OR = 1.47; 95% CI: 1.08–2.02). Additional risks included tomography (OR = 1.88; 95% CI: 1.43–2.46) and ventilatory support (OR = 1.80; 95% CI: 1.49–2.17). |
Conde 2018 | Cross-Sectional Study | Brazil | 2015 | 16,556 | Overweight, obesity, underweight | Self-identification | The study highlighted an increase in overweight and obesity prevalence among Black and Indigenous adolescents compared to previous years. While White adolescents had a higher overall prevalence of overweight, Indigenous adolescents demonstrated greater odds of being overweight, with a prevalence of 22.5% (OR = 1.02, 95% CI: 1.01–1.03). Additionally, individuals of Indigenous background exhibited the second-highest odds of underweight at 3.0% (OR = 1.00, 95% CI: 0.98–1.02), surpassed only by adolescents of Yellow skin color. |
Contreras-Haro 2024 | Cross-Sectional Study | Mexico | 2023 | 378 | Chronic kidney disease (CKD) | Self-identification and surname-based | The prevalence of chronic kidney disease (CKD) was significantly higher in the Wixárika group, with 15% of individuals affected compared to 4% in the mestizo group (p < 0.0001). Members of the Wixárika community exhibited lower levels of education and a higher frequency of alcoholism and elevated blood pressure compared to the mestizo population. Significant predictors of CKD included belonging to the Wixárika ethnic group, with an odds ratio (OR) of 14.27 (95% CI: 3.69–55.1; p < 0.0001), as well as older age (OR = 1.08; 95% CI: 1.03–1.13) and hypertension (OR = 9.93; 95% CI: 2.45–40.0). |
Cuéllar 2022 | Cohort Study | Ecuador | 2020 | 87,762 | Excess deaths of COVID-19 | Self-identification | Indigenous populations had the highest excess death factor (EDF) of 2.2 (220% of expected deaths), compared to 1.36 (136%) in the Mestizo population. While death factors by sex and age in Indigenous groups were similar to the general population, females aged 20–50 had higher death factors than males. Unreported ethnic data post-July 2020 suggests Indigenous groups were disproportionately affected by COVID-19 beyond confirmed death counts. |
Cuevas-Nasu 2019 | Cross-Sectional Study | Mexico | 2012 and 2018 | 2012: 7,141 2018: 2,439 | Undernutrition: Stunting (chronic malnutrition), underweight, and wasting | Language-based | The logistic regression analysis indicated that children under five years of age who speak an Indigenous language had a 2.3-fold greater likelihood of being chronically undernourished (OR = 2.3; 95% CI: 1.3–4.0). Despite this, Indigenous children demonstrated a higher rate of dietary diversity, with 79.5% consuming a varied diet compared to only 20.5% of non-Indigenous children. This dietary diversity serves as a protective factor against chronic undernutrition. The prevalence of chronic undernutrition among Indigenous children under five in 2018 was 24.5% (95% CI: 17.8–32.6), highlighting persistent health disparities. |
Curi-Quinto 2020 | Cross-Sectional Study | Peru | 2015 | Children under 5 years: 22,833 Women of reproductive age (WRA): 33,503 (5,008 adolescents and 28,495 adults) | Malnutrition: overweight/obesity, wasting/underweight, stunting/short stature, and anemia. | Language-based | Indigenous children had higher prevalences of stunting (37.4%) and anemia (45.8%) compared to non-indigenous children (stunting 13.0%, anemia 30.9%), lower prevalence of overweight (3.7%) compared to non-indigenous children (9.2%). Indigenous adolescents had a higher prevalence of stunting (37.1%) compared to non-indigenous adolescents (21.7%). Indigenous adolescents had a lower prevalence of overweight/obesity (22.8%) compared to non-indigenous adolescents (31.7%), a higher prevalence of anemia (21.2%) compared to non-indigenous adolescents (18.7%). Indigenous adult women had a higher prevalence of short stature (50.4%) compared to non-indigenous women (33.4%), a lower prevalence of overweight/obesity (55.3%) compared to non-indigenous women (65.7%) and a higher prevalence of anemia (22.7%) compared to non-indigenous women (20.1%). |
de Campos Gomes 2020 | Cohort Study | Brazil | 1996–2016 | 10,028 | Down syndrome (DS) | Unspecified | Indigenous individuals, particularly women, showed higher mortality rates and lower survival rates for Down syndrome (DS), especially in the North and Midwest regions of Brazil. Indigenous status was strongly associated with increased mortality risk, more evident in women than men. Indigenous individuals with DS also tend to die at a younger age compared to other ethnic groups. Odds ratios varied significantly across regions, ranging from 8.829 to 0.07. |
Góes 2024 | Cohort Study | Brazil | 2004–2015 | 20,665,005 | Breast and cervical cancer | Self-identification | Mortality rates were highest among Indigenous women for cervical cancer (adjusted mortality rate ratio (MRR) = 1.80, 95% CI: 1.39–2.33) compared to White women. Low socioeconomic status (SES) magnified racial inequalities, with larger disparities among women with poorer household conditions and lower education levels. For breast cancer, Black women had the highest mortality rates (MRR = 1.10, 95% CI: 1.04–1.17), while Indigenous women had lower risks compared to White women (MRR = 0.63, 95% CI: 0.44–0.91). |
Gopie 2021 | Cohort Study | Suriname | 2011–2015 | 662 | Tuberculosis | Self-identification | The study revealed that the highest five-year tuberculosis (TB) incidence rates were observed among Indigenous populations (280 per 100,000; 95% CI: 187–374) and Creole populations (271 per 100,000) in Suriname. HIV coinfection was a significant risk factor for TB among Creole patients, with 38.2% being HIV positive. Indigenous TB patients were significantly younger than Creole patients. Even after adjusting for HIV status, Indigenous and Creole populations had higher TB incidence rates compared to other ethnic groups. The elevated TB rates among Indigenous individuals were attributed to factors like poverty and limited access to healthcare, particularly in remote areas. |
Hallal 2020 | Cross-Sectional Study | Brazil | 2020 | First survey: 25,025 Second survey: 31,165 | COVID-19 | Self-identification | The seroprevalence of SARS-CoV-2 in Brazil rose from 1.6% in May to 2.8% in June 2020, with significant regional disparities, notably higher levels along the Amazon River in the northern region. Indigenous people demonstrated a markedly higher seroprevalence (6.3%) compared to White individuals (1.4%), with an odds ratio (OR) of 1.87 (95% CI: 1.18–2.96). Higher seroprevalence was associated with lower socioeconomic status, crowded living conditions, and being in the 20–59 age group. Furthermore, individuals in the poorest quintile had more than double the seroprevalence of those in the wealthiest quintile in both surveys. |
Horta 2021 | Cross-Sectional Study | Brazil | 2020 | 89,397 | COVID-19 | Self-identification | The study highlighted a significantly higher prevalence of SARS-CoV-2 antibodies among Indigenous individuals, with a prevalence ratio of 4.71 (95% CI: 3.65–6.08) compared to White individuals. Similarly, Black and Brown individuals showed higher antibody prevalence rates compared to Whites. There was a notable inverse relationship between wealth and antibody prevalence, as poorer individuals were more likely to have antibodies. Education levels also impacted antibody prevalence, with individuals possessing 12 or more years of schooling exhibiting lower prevalence rates. |
Ibarra-Nava 2021 | Cross-Sectional Study | Mexico | 2020 | 416,546 | COVID-19 | Language-based | The study reveals a higher mortality rate and hospitalization burden among Indigenous populations compared to non-Indigenous groups in both public and private healthcare sectors. Most Indigenous individuals are uninsured or depend on public health systems. Municipalities with higher Indigenous populations had significantly fewer healthcare resources, with 63 clinics, 31 beds, and 86 doctors per 100,000 individuals, compared to municipalities with fewer Indigenous residents, which had 377 clinics, 336 beds, and 670 doctors per 100,000. Indigenous peoples faced an overall COVID-19 mortality rate of 16.5%, compared to 11.1% for non-Indigenous groups. Among hospitalized patients, Indigenous mortality was 37.1%, slightly higher than the 36.3% observed in non-Indigenous patients. Mortality was significantly elevated for Indigenous individuals receiving only ambulatory care (OR 1.55, 95% CI: 1.24–1.92). Additionally, Indigenous individuals were more likely to die outside hospital settings (3.7%) compared to their non-Indigenous counterparts (1.7%). The overall odds of COVID-19 mortality for Indigenous peoples were also higher (OR 1.13, 95% CI: 1.03–1.24). |
Kain 2019 | Cohort Study | Chile | 2011–2017 | 483,509 | Overweight and obesity | Self-identification | The study found that Indigenous children in Chile are at a significantly higher risk of developing overweight or obesity by the time they enter first grade. Approximately 30% of normal-weight preschoolers transitioned to overweight or obesity during this period. Key factors contributing to this trend include being of Indigenous ethnicity, with odds ratios of 1.18 (95% CI: 1.11–1.23) for boys and 1.08 (95% CI: 1.02–1.13) for girls. Additional predictors include attending highly vulnerable schools (OR 1.06 for boys and OR 1.05 for girls), having a mother with only primary education (OR 1.07 for boys and OR 1.19 for girls), and being born with a high birth weight (OR 1.46 for boys and OR 1.47 for girls). |
Lapo-Talledo 2024 A | Cohort Study | Ecuador | 2015–2022 | 1,118,842 | Maternal mortality | Not specified | Maternal mortality peaked in 2020 at 32.22 deaths/100,000 live births before declining to 18.94 in 2022. Ethnic minorities in the “Other” category had significantly higher delivery-related mortality (AOR = 9.59, 95% CI: 6.98–13.18), while Indigenous women showed no significant difference compared to Mestizo women (AOR = 0.61, 95% CI: 0.19–1.93). Higher mortality was also linked to private healthcare (AOR = 1.99) and emergency caesareans (AOR = 7.49). |
Lapo-Talledo 2024 B | Cohort Study | Ecuador | 2015–2022 | 31,616 | Dengue | Self-identification | Indigenous people demonstrated a significantly lower risk of complicated dengue hospitalization (aRRR = 0.44, 95% CI: 0.34–0.55) and in-hospital death (OR = 0.72, 95% CI: 0.10–5.25) compared to Mestizos. |
Little 2023 | Cohort Study | Mexico | 2020–2022 | 10,487,563 | COVID-19 | Self-identification and language-based | Indigenous individuals faced a nearly two-fold unadjusted risk of COVID-19 fatality compared to non-Indigenous individuals (OR = 1.92, 95% CI: 1.86–1.99). However, after full adjustment, the risk was 4% higher (OR = 1.04). Marginalized Indigenous individuals were 1.29 times less likely to be admitted to the ICU and 1.56 times less likely to receive mechanical ventilation. Marginalization increased COVID-19-related death probability by 1.51-fold. Pre-existing conditions, including diabetes, pneumonia, hypertension, and obesity, further amplified COVID-19 mortality risks for Indigenous individuals. |
Mamani Ortiz 2019 | Cross-Sectional Study | Bolivia | 2015 and 2016 | 5,758 | Abdominal obesity | Self-identification | The study found that Indigenous individuals had lower obesity prevalence compared to Mestizo individuals, but experienced less favorable socioeconomic conditions, such as a higher proportion of people with no formal education (9.98%). The disparity in obesity prevalence between Mestizo men and Indigenous women (7.26% higher for Mestizo men) was attributed to ethnic differences. Behavioral risk factors, particularly alcohol consumption and smoking, were more prevalent among Mestizos, while Indigenous individuals displayed healthier eating habits. Abdominal obesity prevalence was highest among Mestizo men (35.01%), followed by Mestizo women (30.71%), Indigenous women (27.75%), and Indigenous men (25.38%). Gender disparities were observed, with Mestizo men having a 4.3% higher prevalence compared to Mestizo women, and ethnic disparities showed a 9.18% higher obesity prevalence in Mestizo men compared to Indigenous men. |
Mazariegos 2020 | Cross-Sectional Study | Guatemala | 2014–2015 | Children younger than 5 years: n = 11,962. Adolescent girls aged 15–19 years: n = 1,086. Women of reproductive age aged 20–49 years: n = 11,354. | Malnutrition | Self-identification | The findings reveal notable disparities in nutritional status across different age groups and socioeconomic strata. Among children under 5 years of age, stunting was significantly more prevalent in Indigenous children, who were 1.7 times more likely to experience stunting compared to their non-Indigenous peers. Conversely, overweight and obesity were more common among wealthier, non-Indigenous children, with non-Indigenous children having a 1.3 times higher prevalence of overweight or obesity (p < 0.05). For adolescent girls, similar patterns emerged, with Indigenous girls showing a 1.7 times higher prevalence of stunting compared to non-Indigenous girls. In contrast, non-Indigenous girls were 1.7 times more likely to exhibit overweight or obesity compared to Indigenous girls (p < 0.05). Among women of reproductive age, Indigenous women had a 1.6 times higher prevalence of stunting compared to non-Indigenous women. However, overweight and obesity were 1.3 times more prevalent among non-Indigenous women (p < 0.05). |
Muñoz-Del-Carpio-Toia 2024 | Cohort Study | Peru | 2016–2021 | 85,905 | Childhood anemia | Self-identification | Quechua, Aymara, Amazonian natives, and other Indigenous children had a higher prevalence of childhood anemia compared to Mestizo children, both before and during the pandemic. Aymara children showed the highest prevalence (PR = 1.35, 95% CI: 1.27–1.44, p < 0.001), followed by other Indigenous children (PR = 1.29, 95% CI: 1.05–1.57, p = 0.013), Amazonian natives (PR = 1.20, 95% CI: 1.12–1.28, p < 0.001), and Quechua children (PR = 1.11, 95% CI: 1.07–1.15, p < 0.001). White children demonstrated a lower prevalence of anemia compared to Mestizo children. |
Mujica-Coopman 2020 | Cross-Sectional Study | Chile | 2016–2017 | 5,082 | Malnutrition | Self-identification | The study found that 12.4% of low SES adults identified as Indigenous, compared to 3% of high SES adults. Obesity was more frequent among Indigenous young women (55.8%) compared to non-Indigenous women (37.2%), while there was no significant difference among older women. Excess weight in men did not vary significantly by SES or ethnicity. However, short stature was more prevalent among Indigenous men (21.5%) compared to non-Indigenous men (8.2%). |
Oliveira 2021 | Cohort Study | Brazil | 2020–2021 | 82,055 | COVID-19 | Self-identification | Indigenous children and adolescents had a significantly higher risk of death compared to White children (HR: 3.36; 95% CI: 2.15–5.24). Mortality rates were also higher in the Northeast and North regions of Brazil compared to the Southeast region. Additionally, the presence of pre-existing medical conditions increased the risk of death, with hazard ratios of 2.96 for individuals with one condition and up to 7.28 for those with three or more conditions. |
Pereira 2022 | Cohort Study | Brazil | 2020–2021 | Mild/moderate cases: 70,056,602 Severe cases: 2,801,380 | COVID-19 | Self-identification | Indigenous individuals had the highest odds of death (OR = 1.42, 95% CI 1.31–1.54) compared to White individuals. Men had higher odds of death than women (OR = 1.14, 95% CI 1.13–1.15), and residents of deprived municipalities also had increased odds (OR = 1.38, 95% CI 1.36–1.40). The risk of death was particularly high for patients requiring ICU admission (OR = 5.19, 95% CI 5.14–5.24). |
Ponce-Alcala 2021 | Cross-Sectional Study | Mexico | 2016 | 5,456 | Obesity | Self-identification and language-based | The prevalence of obesity was significantly higher among women (38.7%) compared to men (28.6%). Severe household food insecurity was strongly associated with an increased likelihood of obesity in women, with an odds ratio (OR) of 2.36 (P = 0.001). Similarly, abdominal obesity was more prevalent in women (87.2%) than men (64.1%), with a significant correlation between severe food insecurity and abdominal obesity among women. Indigenous adults, particularly women, experienced higher levels of food insecurity and greater proportions of obesity compared to non-Indigenous groups. The proportion of household food security among Indigenous individuals was only 12.3% (95% CI: 7.9%, 18.8%; n = 594), much lower than the 30.4% (95% CI: 27.9%, 33.0%; n = 4,862) reported for non-Indigenous individuals. |
Rebouças 2022 | Cohort Study | Brazil | 2012–2018 | 19,515,843 | All-cause child mortality and cause-specific mortality (diarrhea, malnutrition, pneumonia, accidents, and ill-defined causes). | Self-identification | Indigenous children experienced the highest risk of death before the age of 5 years compared to other ethnic groups, with an adjusted hazard ratio (HR) of 1.98 (95% CI: 1.92–2.06) compared to White children. Post-neonatal mortality was significantly higher among Indigenous children (HR: 3.88; 95% CI: 3.68–4.10). The highest mortality risks were for malnutrition (HR: 16.39; 95% CI: 12.88–20.85), diarrhea (HR: 14.28; 95% CI: 12.25–16.65), and pneumonia (HR: 6.49; 95% CI: 5.78–7.27). Indigenous mothers had the lowest proportion of prenatal consultations (28.6% attended less than three), further emphasizing disparities in healthcare access and outcomes. |
Ronquillo De JesĂşs 2022 | Cross-Sectional Study | Mexico | 2020 | 1,037,567 | COVID-19 | Not specified | The case fatality rate for COVID-19 was notably higher among the Indigenous population (14.7%) compared to the non-Indigenous population (9.7%). Severe cases constituted 16.6% of COVID-19 cases in the Indigenous group, whereas they made up only 11.0% in the non-Indigenous group. The prevalence of comorbidities, such as hypertension, obesity, or diabetes, was also higher among Indigenous individuals (42.7%) compared to non-Indigenous individuals (35.3%), although non-Indigenous individuals had a higher prevalence of tobacco use. More than 80% of fatalities occurred in individuals aged 50 or older across both groups. The cumulative incidence rate for the Indigenous population was 94.4 per 100,000, with a death rate of 13.9 per 100,000, while for the non-Indigenous population, the cumulative incidence rate was 900.3 per 100,000, with a death rate of 87.1 per 100,000. |
Salas-Ortiz 2024 | Cross-Sectional Study | Mexico | 2020–2021 | 4,829,071 | COVID-19 | Language-based | The study highlights the inequities faced by Indigenous populations in medical infrastructure, marginalization, and healthcare outcomes during the COVID-19 pandemic. Indigenous individuals experienced higher rates of hospitalization, early death within 5 days, and overall mortality compared to non-Indigenous populations. Equalizing the distribution of comorbidities between Indigenous and non-Indigenous groups could reduce disparities in hospitalizations by 40.6%, early deaths by 42%, and total deaths by 48.4%. Indigenous communities had poorer access to healthcare infrastructure, with an average of 3.45 medical offices and 9.34 hospital beds per community, compared to 5.31 medical offices and 15.52 hospital beds in non-Indigenous areas. Municipal marginalization was slightly lower for Indigenous communities (0.86) than non-Indigenous ones (0.93). Urban localities were less common in Indigenous areas (15.15% compared to 28.11%). Regarding COVID-19 outcomes, 24.9% of Indigenous individuals were hospitalized compared to 12.9% of non-Indigenous individuals. Mortality within 5 days was 5% for Indigenous individuals, more than double the 2.3% rate among non-Indigenous populations. Total mortality was 9.8% for Indigenous individuals, compared to 5.1% for non-Indigenous populations. |
Silva 2017 | Cross-Sectional Study | Brazil | 2015 | 4000 | Depression | Self-identification | Indigenous participants in the study were the least represented but showed the highest prevalence of depressive symptoms at 17.1%. They were three times more likely to exhibit depressive symptoms compared to White participants. Most Indigenous individuals with depressive symptoms were women, belonged to a low social class, and were engaged in informal work or were unemployed. The prevalence ratio for depressive symptoms among Indigenous participants compared to White participants was 2.56 (95% CI: 1.24–5.30). |
Soto 2019 | Case-Control Study | Chile | 2017–2018 | 104 | Incident stroke | Self-identification | This study found no association between Mapuche ethnicity and stroke. Although control variables such as hypertension, overweight/obesity, low socioeconomic status, rurality, diabetes, and smoking were associated with either stroke (outcome variable) or Mapuche ethnicity (exposure variable), none altered the effect of ethnicity on stroke. The odds ratio (OR) for Mapuche ethnicity and stroke was 0.75 (95% CI: 0.35–1.62, p = 0.47), indicating no significant association. |
Vinueza Veloz 2023 | Cross-Sectional Study | Ecuador | 2018 | 89,212 | Malnutrition | Self-identification | The study found variations in BMI across different demographics and ethnic groups. Women had a 1.03 kg/m² higher BMI than men, and BMI increased by 0.04 kg/m² per year of age. Married individuals had a 1.14 kg/m² higher BMI compared to single individuals. Indigenous participants had a BMI 0.78 kg/m² lower than White participants, while Montubio and Afro-American individuals had 0.37 and 0.61 kg/m² higher BMI, respectively. Urban residents also showed a 0.41 kg/m² higher BMI than rural residents. The multivariate analysis indicated a coefficient of -0.79 (95% CI: -1.02, -0.56) for Indigenous nutritional status, reflecting lower BMI levels. |