Assessing the impact of social factors and interventions on healthy growth and development: the cohort of 100 million Brazilians

Development and implementation of the first Brazilian Center for Data and Knowledge Integration, known as Cidacs. Comprised of data from the Cadastro Único (CadÚnico) and Bolsa Família Program (2004 to 2015), Cidacs merges this information to other databases, including the Mortality Information System (SIM, 2000 to 2015), Live Birth Information System (Sinasc de 2001 to 2015) and the Food and Nutrition Surveillance System (Sisvan), which is still under development. Together, they form the Cohort of 100 Million Brazilians, the largest in the country. The merging of official data on social and economic conditions of the population with clinical information on diseases and other conditions allows us to draw conclusions about how these factors, called social determinants, can be harmful to health.

The first surveys – currently 30 are underway – using the Cidacs database, which were part of the initial study funded by Grand Challenges Brazil, focused on the following maternal and child health topics below and the impacts of the Bolsa Família Program (PBF):

1. Estimate the effect of social and economic determinants on mortality of children under five in Brazil
2. Estimate the effect of social and economic factors, prenatal care and maternal characteristics on birth weight
3. Analyze the social determinants related to prematurity of live births in Brazil from 2012 to 2015
4. Estimate the impact of the Bolsa Família Program (PBF) on infant (up to 1 year) and child (up to 5 years) mortality
5. Assess the impact of PBF on prematurity through a cross-sectional study nested in a cohort of families enrolled in CadÚnico
6. Assess the impact of PBF on reducing low birth weight
7. Estimate the impact of the PBF on maternal mortality from 2006 to 2015

Due to the merging of data, it was possible to estimate the impact of the PBF on infant (up to 1 year) and child (up to 5 years) mortality. As compared to non-beneficiary families, after the birth of a child, families that are beneficiaries of the program see an approximately 70% reduction in the chance of death in childhood. Among the beneficiaries, the chances of dying in this stage of life is lowered by 18%, as compared to children who did not benefit from the program. Studies also show that when a person with leprosy participates in the Bolsa Família program adherence to treatment increases by about 22% and the cure rate increases by 26%.

It is the first time that a database and a cohort of 100 million people has been established in Brazil and in developing or middle-income countries.

By transforming national administrative data into research data, Cidacs allows researchers to generate evidence related to the health impacts of social determinants and social programs. It has also guided the decision-making process, bridging the gap between science and policy and allowing for the generation of evidence-based public policies.

Cidacs has provided data to dozens of health research projects around Brazil and the world. It also stands out as an information generation tool to guide management. That is why it has attracted the attention of organizations around the world, in addition to Brazilian and international public health professionals.

Due to the gigantic sample of more than 100 million individuals, evidence on the effects of social determinants on health and the impacts of social programs to address them can be expanded to different contexts and, therefore, used to guide health management in other countries as well.

The team responsible for Cidacs is now devising ways to make the center sustainable so that it can continue to fulfill its role and further expand the number of Brazilian and international health and data science studies that use its databases to generate evidence. The Center inspired the launch of a call for proposals for research in data science in 2018, and a second in 2020, and partnered with several of the projects from these calls[VW2] . The center has also joined another FBMG initiative, which incorporates knowledge about maternal and child health in India and Africa (Knowledge Integration).