Changes in COPD treatment in Brazil: Findings from the National Health Surveys

Background: Undertreatment of chronic obstructive pulmonary disease (COPD) is still a major problem in Brazil. Inadequate treatment can lead to increased costs to the population and high mortality. We aimed to examine the changes in the proportion of people receiving pharmacological treatment for COPD among adults, aged 40 years or older, from 2013 to 2019 in Brazil. Methods: Data from the 2013 and 2019 Brazilian National Health Surveys were used. Participants with a self-reported medical diagnosis of COPD were asked about pharmacological treatment for disease management. To characterise the changes in the proportion of people with COPD receiving treatment, we considered the following factors: region (North, Northeast, Central-West, Southeast and South), place of residence (urban/rural), sex (male/female), age (40-49, 50-59, >60) and race (White, Black, Mixed, Indigenous and Asian). We calculated the difference between the surveys and expressed them as percentage points (pp) with their respective 95% confidence interval (95%CI). Results: The sample comprised 636 individuals in 2013 and 989 in 2019. Pharmacological treatment increased from 47.6% in 2013 to 54.7% in 2019. This increase was higher among women (9.8pp), the elderly (12.7pp) and Black race individuals (15.4pp). Although treatment increased in both urban and rural areas, the difference between these is still notable: 55.5% vs 47.2%, respectively. The increase was higher in the North (22pp, 95%CI 17.7-27.3) and Northeast (21.5pp, 95%CI 16.8-26.1) regions, but similar results were not found in the other regions. Conclusion: The proportions of pharmacological treatment rose from 2013 to 2019. However, huge inequalities still persist in Brazil.