Journal
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Volume 51, Issue 6, Pages 1847-1861Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ije/dyac188
Keywords
Cardiovascular disease; mortality; conditional cash transfer; Bolsa Familia Programme; Family Health Strategy
Categories
Funding
- National Institute for Health Research (NIHR) [GCRF/16/137/99]
- UK Government
- UK Medical Research Council [MC_UU_00022/2]
- Scottish Government Chief Scientist Office [SPHSU17]
- Wellcome Trust UK [202912/B/16/Z]
- Brazilian National Council for Scientific and Technological Development (CNPq)/Ministerio da Sau' de (MS)/Bill & Melinda Gates Foundation [401739/2015-5]
- National Health Service Research Scotland (NRS) Senior Clinical Fellowship [SCAF/15/02]
- Wellcome Trust [202912/B/16/Z] Funding Source: Wellcome Trust
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The largest conditional cash transfer program in Brazil, Bolsa Familia Programme (BFP), has a small to null effect on premature cardiovascular disease (CVD) and all-cause mortality in the short term. The long-term impact remains unknown.
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 Familia 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.
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