OBJECTIVES: To assess the economic burden of COPD according to types of benefits, on Brazilian social security system.

METHODS: We included benefits granted by the National Institute of Social Security (INSS), in a 10y period (2014-2023), for beneficiaries with age between 40y and expected retirement by age (men 65y; women 60-62y), related to 16 ICD codes for COPD, chronic bronchitis, and pulmonary emphysema. Economic burden was measured by amount, duration, total productivity loss and estimated expenditure on benefits. Duration of long-term benefits (retirement and social assistance) was estimated considering the average life expectancy, according to sex and age, adjusting Brazilian life tables for the excess mortality attributable to COPD and limiting to the observed period and expected retirement age. Expenditures were adjusted for inflation until December 2023.

RESULTS: From 52,560 benefits identified, 42,380 benefits were included for profile (63% male, mean age 56.1±5.5y) and 42,340 for economic burden (40 registers with inconsistency in dates excluded). Mean annual benefits was 2.03/100,000 population (95%CI 1.96–2.09), higher in the south (Rio Grande do Sul: 5.07/100,000), reducing towards north (Roraima 0.45/100,000). Total benefit duration was 14.4±21.2 months, total productivity loss 609,800 months and expenditure was R$1.02 billion, majorly due to early retirements (R$567 million), followed by social assistance (R$277 million), and aid/benefit (R$174 million). This pattern of expense distribution was generally sustained when analysed by year of payment.

CONCLUSIONS: In the last 10 years, Brazilian social security system received a burden greater than 1 billion BRL only related to COPD, mainly driven by early retirement. These results showed the economic impact of COPD-related benefits, straining public resources. Benefits were also unevenly distributed across the country, which spans a continental dimension in case of Brazil.