Impact of non-contributory pension on mortality among older adults in Brazil

Background

Non-contributory pensions are central to social protection systems in low- and middle-income countries, yet evidence on their health effects remains limited. In Brazil, the Continuous Cash Benefit (BPC) provides a minimum wage to older adults living in poverty, but its impact on mortality is unclear.

Methods

We conducted a quasi-experimental study using linked administrative data from the 100 Million Brazilian Cohort, BPC payment records, and national mortality systems. The study population includes individuals aged ≥50 years, followed from 2016 to 2020. Exposure is defined as initiation of BPC receipt. We implemented a fuzzy regression discontinuity design exploiting the age eligibility threshold at 65 years. Local polynomial regressions with robust bias-corrected bandwidths were used to estimate effects near the cutoff.

Results

We observed a clear discontinuity in the probability of receiving BPC at age 65, increasing by approximately 40 percentage points at the eligibility threshold, supporting the fuzzy RD design. Mortality increases smoothly with age, with a modest discontinuity at the eligibility threshold. Sharp RD estimates indicate a small but statistically significant reduction in mortality of approximately 2.1 percentage points at age 65 (−0.021; 95% CI: −0.025 to − 0.017). Fuzzy RD estimates suggest a larger local average treatment effect among eligible individuals who take up the benefit (−0.051; 95% CI: −0.061 to − 0.041).

Conclusions

These findings provide initial evidence on the health effects of a large-scale non-contributory pension in Brazil. While eligibility strongly increases benefit receipt, the estimated effects on mortality are modest in magnitude and should be interpreted cautiously. The RD design identifies local effects around the eligibility threshold and may not capture longer-term impacts. This underscores the importance of assessing longer-term and dynamic effects of income support using survival models.

Key messages

• Non-contributory pensions can generate measurable health gains, highlighting the role of income support policies in reducing mortality among vulnerable older populations.

• BPC eligibility at age 65 sharply increases benefit receipt and is associated with a modest reduction in mortality, suggesting income support can improve health among older adults living in poverty.