Evaluating the impact of the Bolsa Familia conditional cash transfer program on premature cardiovascular and all-cause mortality using the 100 million Brazilian cohort: A natural experiment study protocol

Pescarini, J. M., Craig, P. , Allik, M. , Amorim, L., Ali, S., Smeeth, L., Barreto, M. L., Leyland, A. H. , Aquino, E. M.L. and Katikireddi, S. V. (2020) Evaluating the impact of the Bolsa Familia conditional cash transfer program on premature cardiovascular and all-cause mortality using the 100 million Brazilian cohort: A natural experiment study protocol. BMJ Open, 10, e039658. (doi: 10.1136/bmjopen-2020-039658) (PMCID:PMC7682454)

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Abstract

Introduction: Brazil’s Bolsa Familia Program (BFP) is the world’s largest conditional cash transfer scheme. We shall use a large cohort of applicants for different social programmes to evaluate the effect of BFP receipt on premature all-cause and cardiovascular mortality. Methods and analysis: We will identify BFP recipients and non-recipients among new applicants from 2004 to 2015 in the 100 Million Brazilian Cohort, a database of 114 million individuals containing sociodemographic and mortality information of applicants to any Brazilian social programme. For individuals applying from 2011, when we have better recorded income data, we shall compare premature (age 30–69) cardiovascular and all-cause mortality among BFP recipients and non-recipients using regression discontinuity design (RDD) with household monthly per capita income as the forcing variable. Effects will be estimated using survival models accounting for individuals follow-up. To test the sensitivity of our findings, we will estimate models with different bandwidths, include potential confounders as covariates in the survival models, and restrict our data to locations with the most reliable data. In addition, we will estimate the effect of BFP on studied outcomes using propensity score risk-set matching, separately for individuals that applied ≤2010 and >2011, allowing comparability with RDD. Analyses will be stratified by geographical region, gender, race/ethnicity and socioeconomic position. We will investigate differential impacts of BFP and the presence of effect modification for a combination of characteristics, including gender and race/ethnicity. Ethics and dissemination: The study was approved by the ethics committees of Oswaldo Cruz Foundation and the University of Glasgow College of Medicine and Veterinary Life Sciences. The deidentified dataset will be provided to researchers, and data analysis will be performed in a safe computational environment without internet access. Study findings will be published in high quality peer-reviewed research articles. The published results will be disseminated in the social media and to policy-makers.

Item Type:Articles
Additional Information:This research was funded by the National Institute for Health Research (NIHR) (GHRG /16/137/99) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13). SVK is funded by a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02). Cidacs/Fiocruz is supported by grants from CNPq/MS/Gates Foundation (401739/2015-5) and the Wellcome Trust, UK (202912/Z/16/Z).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Craig, Professor Peter and Leyland, Professor Alastair and Allik, Dr Mirjam
Authors: Pescarini, J. M., Craig, P., Allik, M., Amorim, L., Ali, S., Smeeth, L., Barreto, M. L., Leyland, A. H., Aquino, E. M.L., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2020.
First Published:First published in BMJ Open 10:e039658
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
300390Strengthening data linkage to reduce health inequalities in low and middle income countries: building on the Brazilian 100 million cohortAlastair LeylandNational Institute for Health Research (NIHR)16/137/99HW - MRC/CSO Social and Public Health Sciences Unit
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiChief Scientist Office (CSO)SCAF/15/02HW - Public Health