Air Pollution Signals and National Demand for Asthma Medication in Brazil Between 2018-2023: Should It Be Considered a Public-Health Concern?
Author(s)
Tulio Tadeu R. Sarmento, MSc, BPharm1, FABIANA GATTI DE MENEZES, MSc, PharmD, PhD2, Wender Aparecido Oliveira, BBA3, Wender A. De Oliveira, Postgraduate, MBA4.
1UFMG, Belo Horizonte, Brazil, 2Head of Evidence Generation & Health Innovation, Chiesi Brazil, São Paulo, Brazil, 3Senior Director of Market Access & Public Affairs, Chiesi Brazil, Sao Paulo, Brazil, 4Chiesi Brazil, Sao Paulo, Brazil.
1UFMG, Belo Horizonte, Brazil, 2Head of Evidence Generation & Health Innovation, Chiesi Brazil, São Paulo, Brazil, 3Senior Director of Market Access & Public Affairs, Chiesi Brazil, Sao Paulo, Brazil, 4Chiesi Brazil, Sao Paulo, Brazil.
OBJECTIVES: Brazil’s Farmácia Popular program (FP) reimburses private pharmacies for dispensing asthma medications, among others. This study investigates whether monthly variations in national beclomethasone dispensations are associated with large-scale atmospheric pollution.
METHODS: Monthly panel (2018-2023) of beclomethasone doses reimbursed by FP was obtained via Brazil’s Freedom-of-Information Act. Counts were normalized to doses / 100,000 inhabitants using IBGE estimates. The series was enriched with gridded (0.25°×0.25°) data from the Copernicus Atmosphere Monitoring Service: total-column SO₂ (TCSO₂), NO₂ (TCNO₂), CO (TCCO) and relative humidity (RH). Monthly dispensation values were population-weighted across municipalities. Linear associations were screened with Pearson’s r. A multivariate Poisson Generalized Linear Model (GLM) with robust (HAC, lag = 3) standard errors modelled contemporaneous effects of each pollutant, adjusting for RH. Pollutants were entered as z-scores; coefficients were exponentiated to incidence-rate ratios (IRRs). Data from 2020 were excluded due to COVID-19 pandemics impacts.
RESULTS: Beclomethasone dispensations correlated moderately with TCSO₂ (r = 0.61, p < 0.001) and weakly with TCNO₂ (r = 0.48, p < 0.001); no correlation found for TCCO (r = 0.06, p = 0.67). In the multivariate model (48 monthly observations, pseudo-R² = 0.28), a one-standard-deviation rise in TCSO₂ was associated to a 6.9% increase in Beclomethasone dispensations (β = 0.066, IRR = 1.069; 95%CI 1.00-1.14; p = 0.053). TCNO₂ and TCCO showed no independent association (p-value > 0.55). Decreases in relative humidity was significantly correlated to increase in beclomethasone demand (p = 0.001).
CONCLUSIONS: Monthly increases in TCSO₂—often signaling biomass-burning plumes—coincide with higher demand for asthma medication in Brazil. Although only marginally significant after weather adjustment, the finding underscores the respiratory burden of large-scale pollution events. Longer time series and finer-scale exposure metrics are expected to refine these findings.
METHODS: Monthly panel (2018-2023) of beclomethasone doses reimbursed by FP was obtained via Brazil’s Freedom-of-Information Act. Counts were normalized to doses / 100,000 inhabitants using IBGE estimates. The series was enriched with gridded (0.25°×0.25°) data from the Copernicus Atmosphere Monitoring Service: total-column SO₂ (TCSO₂), NO₂ (TCNO₂), CO (TCCO) and relative humidity (RH). Monthly dispensation values were population-weighted across municipalities. Linear associations were screened with Pearson’s r. A multivariate Poisson Generalized Linear Model (GLM) with robust (HAC, lag = 3) standard errors modelled contemporaneous effects of each pollutant, adjusting for RH. Pollutants were entered as z-scores; coefficients were exponentiated to incidence-rate ratios (IRRs). Data from 2020 were excluded due to COVID-19 pandemics impacts.
RESULTS: Beclomethasone dispensations correlated moderately with TCSO₂ (r = 0.61, p < 0.001) and weakly with TCNO₂ (r = 0.48, p < 0.001); no correlation found for TCCO (r = 0.06, p = 0.67). In the multivariate model (48 monthly observations, pseudo-R² = 0.28), a one-standard-deviation rise in TCSO₂ was associated to a 6.9% increase in Beclomethasone dispensations (β = 0.066, IRR = 1.069; 95%CI 1.00-1.14; p = 0.053). TCNO₂ and TCCO showed no independent association (p-value > 0.55). Decreases in relative humidity was significantly correlated to increase in beclomethasone demand (p = 0.001).
CONCLUSIONS: Monthly increases in TCSO₂—often signaling biomass-burning plumes—coincide with higher demand for asthma medication in Brazil. Although only marginally significant after weather adjustment, the finding underscores the respiratory burden of large-scale pollution events. Longer time series and finer-scale exposure metrics are expected to refine these findings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD15
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks, Health & Insurance Records Systems
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)