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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
  1. Julia M Pescarini1,2,
  2. Peter Craig3,
  3. Mirjam Allik3,
  4. Leila Amorim4,
  5. Sanni Ali1,5,
  6. Liam Smeeth5,6,
  7. Mauricio L Barreto1,7,
  8. Alastair H Leyland3,
  9. Estela M L Aquino1,7,
  10. Srinivasa Vittal Katikireddi3
  1. 1Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
  2. 2Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  3. 3MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
  4. 4Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
  5. 5Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  6. 6Health Data Research (HDR), London, UK
  7. 7Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
  1. Correspondence to Dr Julia M Pescarini; juliapescarini{at}


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.

  • Health policy
  • public health
  • cardiac epidemiology
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors JMP, PC, EMLA and SVK wrote the first draft of the protocol. MA, LA, SA, LS, MLB and AHL contributed with additional material. All authors participated with the discussions during the development of this protocol and reviewed the final version.

  • Funding 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).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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