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. 2025 Mar;13(3):e508-e516.
doi: 10.1016/S2214-109X(24)00508-4.

Associations between the Bolsa Familia conditional cash transfer programme and substance use disorder hospitalisations: a quasi-experimental study of the 100 Million Brazilian Cohort

Lidiane Toledo  1 , Erika Fialho  2 , Flávia Alves  3 , Maurício L Barreto  2 , Vikram Patel  4 , Daiane B Machado  3
Affiliations

Associations between the Bolsa Familia conditional cash transfer programme and substance use disorder hospitalisations: a quasi-experimental study of the 100 Million Brazilian Cohort

Lidiane Toledo et al. Lancet Glob Health. 2025 Mar.

Abstract

Background: Although low socioeconomic status is a recognised risk factor for substance use disorders (SUDs), the potential of socioeconomic interventions, such as conditional cash transfer programmes, to mitigate this burden remains poorly explored. Our study investigated whether the Brazilian conditional cash transfer, the Bolsa Familia Program (BFP) was associated with reduced SUD hospitalisations (ie, both admission to and treatment within hospital).

Methods: This quasi-experimental study used national administrative hospitalisation and BFP payroll records linked to the 100 Million Brazilian Cohort baseline from 2008 to 2015. We used Poisson regression models with inverse probability of treatment weighting, using the propensity score, to evaluate the association of the BFP with SUD hospitalisations.

Findings: The study included 35 926 326 individuals registered at baseline from 2008 to 2015. BFP benefit was associated with a lower risk of SUD hospitalisations overall (incidence rate ratios [IRR] 0·83, 95% CI 0·81-0·85). BFP benefit was also associated with both a lower risk of alcohol-related hospitalisations (0·74, 0·71-0·77) and a lower risk of hospitalisations due to other substances except alcohol (0·89, 0·86-0·92). Both male and female beneficiaries had a lower risk of SUD hospitalisation compared with non-beneficiaries. We observed an increased gradient of protection against SUD hospitalisations among beneficiaries of the BFP as municipal deprivation increased. The reduction was 10% (IRR 0·90, 0·87-0·92) in less deprived municipalities and 41% (0·59, 0·49-0·71) in highly deprived municipalities.

Interpretation: Receiving BFP benefit was associated with lower risk of SUD hospitalisation, implicating conditional cash transfers as a potential tool to respond to SUD-related issues in individuals experiencing poverty. This protective association could be mediated by alleviating poverty, fulfilling basic needs, improving socioeconomic status, enhancing health access, and promoting education.

Funding: National Institute of Mental Health-National Institutes of Health.

Translation: For the Portuguese translation of the abstract see Supplementary Materials section.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure:
Figure:
Flowchart of the study population
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References

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