Impact of Brazil’s Bolsa Familia Programme on cardiovascular and all-cause mortality: a natural experiment study using the 100 Million Brazilian Cohort

Pescarini, J. M. et al. (2022) Impact of Brazil’s Bolsa Familia Programme on cardiovascular and all-cause mortality: a natural experiment study using the 100 Million Brazilian Cohort. International Journal of Epidemiology, 51(6), pp. 1847-1861. (doi: 10.1093/ije/dyac188) (PMID:36172959) (PMCID:PMC9749722)

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Background: Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world's largest conditional cash transfer, Brazil’s Bolsa Família Programme (BFP). Methods: We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt and national mortality data. We followed individuals who applied for BFP between 1 January 2011 and 31 December 2015, until 31 December 2015. We used marginal structural models to estimate the effect of BFP on all-age and premature (30–69 years) CVD and all-cause mortality. We conducted stratified analyses by levels of material deprivation and access to healthcare. We checked the robustness of our findings by restricting the analysis to municipalities with better mortality data and by using alternative statistical methods. Results: We studied 17 981 582 individuals, of whom 4 855 324 were aged 30–69 years. Three-quarters (76.2%) received BFP, with a mean follow-up post-award of 2.6 years. We detected 106 807 deaths by all causes, of which 60 893 were premature; and 23 389 CVD deaths, of which 15 292 were premature. BFP was associated with reductions in premature all-cause mortality [hazard ratio (HR) = 0.96, 95% CI = 0.94–0.98], premature CVD (HR = 0.96, 95% CI = 0.92–1.00) and all-age CVD (HR = 0.96, 95% CI = 0.93–1.00) but not all-age all-cause mortality (HR = 1.00, 95% CI = 0.98–1.02). In stratified and robustness analyses, BFP was consistently associated with mortality reductions for individuals living in the two most deprived quintiles. Conclusions: BFP appears to have a small to null effect on premature CVD and all-cause mortality in the short term; the long-term impact remains unknown.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Craig, Professor Peter and Shaw, Dr Richard and Campbell, Dr Desmond and Leyland, Professor Alastair and Allik, Dr Mirjam
Authors: Pescarini, J. M., Campbell, D., Amorim, L. D., Falcão, I. R., Ferreira, A. J. F., Allik, M., Shaw, R. J., Malta, D. C., Ali, M. S., Smeeth, L., Barreto, M. L., Leyland, A., Craig, P., Aquino, E. M. L., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:International Journal of Epidemiology
Publisher:Oxford University Press
ISSN (Online):1464-3685
Published Online:28 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in International Journal of Epidemiology 51(6): 1847-1861
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)16/137/99SHW - MRC/CSO Social & Public Health Sciences Unit
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02SHW - Public Health