Bolsa Família Program and deaths from oral cancer in Brazil: an ecological study

Abstract

Objective. To assess the effect of coverage of the Bolsa Família Program (BFP) on oral cancer mortality rates in Brazil between 2005 and 2017, adjusting for health care coverage and socioeconomic characteristics of the Brazilian federative units. Methods. This is an ecological study using annual data (2005–2017) from all the Brazilian federative units. The dependent variable for this study was the oral cancer mortality rate, standardized by gender and age using the direct standardization technique. BFP coverage was the main independent variable, calculated as the ratio of the number of BFP beneficiaries to those families that should potentially be entitled to this conditional cash transfer. Socioeconomic background and health care coverage were covariables. Choropleth maps were drawn, and space-time cube analysis was used to assess changes in the spatiotemporal distribution of BFP and oral cancer mortality rates. Mixed-effects linear regression analysis estimated the coefficients (β) and 95% confidence intervals (CI) for the association between BFP coverage and oral cancer mortality rates. Results. BFP coverage trends increased and oral cancer mortality rate trends stabilized in Brazilian federative units, except for Maranhão, Goiás, and Minas Gerais, where the oral cancer mortality rates have increased. In the adjusted model, greater BFP coverage was associated with lower oral cancer mortality rates (β –2.10; 95% CI [–3.291, –0.919]). Conclusions. Egalitarian strategies such as BFP can reduce the oral cancer mortality rate. We recommend the follow-up of families benefiting from conditional cash transfer program by oral health teams to reduce the oral cancer mortality rate.