Dandara de Oliveira Ramos
@ufba.br
Associate Professor at the Institute of Collective Health, Federal University of Bahia, Brazil
Federal University of Bahia
The main focus of DR's research is to analyze the impact of adverse exposures (e.g. poverty, violence, income inequality), on the health and development of vulnerable populations in different life stages.
EDUCATION
She holds a degree in Psychology (UERJ - 2009), a Master's in Social Psychology (UERJ -2012), a PhD in Epidemiology (IMS UERJ/McMaster University - 2017) and is a Adjunct Professor at the Institute of Collective Health of the Federal University of Bahia, Brazil.
RESEARCH, TEACHING, or OTHER INTERESTS
Epidemiology, Psychology, Social Psychology, Public Health, Environmental and Occupational Health
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Naiá Ortelan, Márcia Furquim de Almeida, Elzo Pereira Pinto Júnior, Nivea Bispo, Rosemeire L. Fiaccone, Ila Rocha Falcão, Aline dos Santos Rocha, Dandara Ramos, Enny S. Paixão, Rita de Cássia Ribeiro-Silva,et al.
Springer Science and Business Media LLC
Abstract Background Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. Methods A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32–36), (iii) severe (28–31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. Results 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63–0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59–0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43–0.74). Conclusions An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
Mabel Carabali, Sharrelle Barber, Andrea J.F. Ferreira, Ana F. Ortigoza, Dandara Ramos, Emanuelle Goes, Arjumand Siddiqi, Diego I. Lucumi, Dennis Perez-Chacon, John W. Jackson,et al.
Elsevier BV
Poliana Rebouças, Enny S. Paixão, Dandara Ramos, Julia Pescarini, Elzo Pereira Pinto-Junior, Ila R. Falcão, Maria Yury Ichihara, Samila Sena, Rafael Veiga, Rita Ribeiro,et al.
Elsevier BV
Ana Cristina de Oliveira Costa, Dandara de Oliveira Ramos, and Romulo Paes de Sousa
FapUNIFESP (SciELO)
Resumo O objetivo deste estudo foi identificar indicadores de desigualdades sociais associados à mortalidade por neoplasias na população adulta brasileira. Utilizou-se como método a revisão de escopo, estabelecendo-se a pergunta norteadora: qual o efeito das desigualdades sociais na mortalidade por neoplasias na população adulta brasileira? Foram identificados 567 trabalhos, sendo 22 considerados elegíveis. Identificou-se uma diversidade de indicadores, como o Índice de Desenvolvimento Humano e o Índice de Gini, entre outros, que avaliaram primordialmente diferenças de renda, escolarização, desenvolvimento humano e vulnerabilidade. Não foi estabelecido um único padrão de associação entre os indicadores e as diferentes neoplasias, assim como não se identificou um indicador único capaz de explicar o efeito da desigualdade social em todos os níveis de área e por óbitos por todos os tipos de neoplasias, mas identificou-se que a mortalidade é influenciada pelas desigualdades sociais e que o estudo dos indicadores proporciona definir qual melhor explica os óbitos. Essa revisão destaca importantes lacunas referentes ao uso de indicadores sociais não modificáveis, à análise de pequenas áreas e ao uso limitado de indicadores multidimensionais.
Daiane Borges Machado, Noemia Teixeira de Siqueira Filha, Fanny Cortes, Luís F.S. Castro-de-Araujo, Flavia Jôse Oliveira Alves, Dandara Ramos, Erika Fialho Xavier, Fernando Zanghelini, William Rudgard, David K. Humphreys,et al.
Elsevier BV
Caroline Castro, Lisiane Leal, Dandara Ramos, Jerusa Santana, Rosa Cordeiro, Maria da Conceição Rivemales, Edna Araújo, Carlos Silva, Marcos Pereira, and Djanilson Santos
Informa UK Limited
Purpose This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region. Patients and Methods A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white). Results Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27–73.72%), analgesics (21.74%; 95% CI 19.36–24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57–21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy. Conclusion A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.
Temidayo James Aransiola, José Alejandro Ordoñez, Daniella Medeiros Cavalcanti, Gabriel Alves de Sampaio Morais, Dandara de Oliveira Ramos, and Davide Rasella
Elsevier BV
Alessandra A. S. Menezes, Dandara O. Ramos, Zila M. Sanchez, and Richard Miskolci
Springer Science and Business Media LLC
Flávia Jôse O. Alves, Dandara Ramos, Enny S. Paixão, Ila R. Falcão, Rita de Cássia Ribeiro-Silva, Rosemeire Fiaccone, Davide Rasella, Camila Teixeira, Daiane Borges Machado, Aline Rocha,et al.
American Medical Association (AMA)
ImportanceConditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality.ObjectiveTo evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage.Design, Setting, and ParticipantsThis cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022.Main Outcome(s) and MeasuresMaternal death.ResultsA total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups.Conclusions and RelevanceThis cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.
Emanuelle Freitas Góes, Andrêa J.F. Ferreira, and Dandara Ramos
FapUNIFESP (SciELO)
Abstract Anti-Black Racism traverses the lives of Black and Brown women, compromising sexual and reproductive health. Obstetric racism during pregnancy, prenatal care, childbirth, abortion, and puerperium affects these women, exposing them to harmful and often lethal maternal outcomes. This study aims to present racism and its manifestations in maternal death by COVID-19. It included data from COVID-19 notifications among pregnant women and puerperae recorded in the severe acute respiratory syndrome database (2021 and 2022). Information on race/skin color, age, region, clinical signs and symptoms, ICU, and deaths were collected. The results indicate how racism affects Black and Brown pregnant women and puerperae, who have higher lethality due to COVID-19 compared to White women (a difference of 14.02%), particularly in the puerperium. Black and Brown pregnant women least accessed the ICU. After adjustments, maternal death in the puerperium for Black women was 62% more likely than for White women (OR=1.62; 95%CI: 1.01-2.63). Racism and its manifestations (dis)organize the reproductive trajectories of Black and Brown women, whose interaction with sexism contributes to harmful and lethal maternal outcomes by COVID-19.
Poliana Rebouças, Emanuelle Goes, Julia Pescarini, Dandara Ramos, Maria Yury Ichihara, Samila Sena, Rafael Veiga, Laura C Rodrigues, Maurício L Barreto, and Enny S Paixão
Elsevier BV
Dandara de Oliveira Ramos, Emanuelle Freitas Goes, and Andrêa Jacqueline Fortes Ferreira
Springer Science and Business Media LLC
Mauricio L Barreto, Maria Yury Ichihara, Julia M Pescarini, M Sanni Ali, Gabriela L Borges, Rosemeire L Fiaccone, Rita de Cássia Ribeiro-Silva, Carlos A Teles, Daniela Almeida, Samila Sena,et al.
Oxford University Press (OUP)
on leprosy and child mortality. Other studies are now being conducted that are of utmost relevance to the health inequalities of Brazil and many low- and middle-income countries, and many research opportunities are being opened up with the linkage of a range of health outcomes.
Maria Yury Ichihara, Andrêa J.F. Ferreira, Camila S. S. Teixeira, Flávia Jôse O. Alves, Aline Santos Rocha, Victor Hugo Dias Diógenes, Dandara Oliveira Ramos, Elzo Pereira Pinto Júnior, Renzo Flores-Ortiz, Leila Rameh,et al.
Universidade de Sao Paulo, Agencia USP de Gestao da Informacao Academica (AGUIA)
OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
Dandara Ramos, Nívea B. da Silva, Maria Yury Ichihara, Rosemeire L. Fiaccone, Daniela Almeida, Samila Sena, Poliana Rebouças, Elzo Pereira Pinto Júnior, Enny S. Paixão, Sanni Ali,et al.
Public Library of Science (PLoS)
Background Brazil has made great progress in reducing child mortality over the past decades, and a parcel of this achievement has been credited to the Bolsa Família program (BFP). We examined the association between being a BFP beneficiary and child mortality (1–4 years of age), also examining how this association differs by maternal race/skin color, gestational age at birth (term versus preterm), municipality income level, and index of quality of BFP management. Methods and findings This is a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a population-based cohort primarily built from Brazil’s Unified Registry for Social Programs (Cadastro Único). We analyzed data from 6,309,366 children under 5 years of age whose families enrolled between 2006 and 2015. Through deterministic linkage with the BFP payroll datasets, and similarity linkage with the Brazilian Mortality Information System, 4,858,253 children were identified as beneficiaries (77%) and 1,451,113 (23%) were not. Our analysis consisted of a combination of kernel matching and weighted logistic regressions. After kernel matching, 5,308,989 (84.1%) children were included in the final weighted logistic analysis, with 4,107,920 (77.4%) of those being beneficiaries and 1,201,069 (22.6%) not, with a total of 14,897 linked deaths. Overall, BFP participation was associated with a reduction in child mortality (weighted odds ratio [OR] = 0.83; 95% CI: 0.79 to 0.88; p < 0.001). This association was stronger for preterm children (weighted OR = 0.78; 95% CI: 0.68 to 0.90; p < 0.001), children of Black mothers (weighted OR = 0.74; 95% CI: 0.57 to 0.97; p < 0.001), children living in municipalities in the lowest income quintile (first quintile of municipal income: weighted OR = 0.72; 95% CI: 0.62 to 0.82; p < 0.001), and municipalities with better index of BFP management (5th quintile of the Decentralized Management Index: weighted OR = 0.76; 95% CI: 0.66 to 0.88; p < 0.001). The main limitation of our methodology is that our propensity score approach does not account for possible unmeasured confounders. Furthermore, sensitivity analysis showed that loss of nameless death records before linkage may have resulted in overestimation of the associations between BFP participation and mortality, with loss of statistical significance in municipalities with greater losses of data and change in the direction of the association in municipalities with no losses. Conclusions In this study, we observed a significant association between BFP participation and child mortality in children aged 1–4 years and found that this association was stronger for children living in municipalities in the lowest quintile of wealth, in municipalities with better index of program management, and also in preterm children and children of Black mothers. These findings reinforce the evidence that programs like BFP, already proven effective in poverty reduction, have a great potential to improve child health and survival. Subgroup analysis revealed heterogeneous results, useful for policy improvement and better targeting of BFP.
Rafael Tavares Jomar, Vitor Augusto de Oliveira Fonseca, and Dandara de Oliveira Ramos
Elsevier BV
Enny S Paixao, Luciana L Cardim, Ila Rocha Falcao, Naiá Ortelan, Natanael de Jesus Silva, Aline dos Santos Rocha, Samila Sena, Daniela Almeida, Dandara Oliveira Ramos, Flávia Jôse Oliveira Alves,et al.
Oxford University Press (OUP)
Cohort Profile: Centro de Integraç~ ao de Dados e Conhecimentos para Saúde (CIDACS) Birth Cohort Enny S Paixao ,* Luciana L Cardim, Ila Rocha Falcao, Naiá Ortelan, Natanael de Jesus Silva, Aline dos Santos Rocha, Samila Sena, Daniela Almeida, Dandara Oliveira Ramos, Flávia Jôse Oliveira Alves, Nı́vea Bispo, Sanni Ali, Rosemeire Fiaccone, Moreno Rodrigues, Liam Smeeth, Elizabeth B Brickley, Liliana Cabral, Carlos Teles, Maria Conceiç~ ao N Costa, Maria Yury Ichihara, Mauricio L Barreto, Rita de Cássia Ribeiro Silva and Maria Gloria Teixeira Centro de Integraç~ao de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil, Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Escola de Nutriç~ao, Universidade Federal da Bahia, Salvador, Brazil, Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil, and Departamento de Estatı́stica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
Dandara Ramos, Emanuelle Góes, Joilda Nery, and Osiyallê Rodrigues
Springer International Publishing
Luciana Dutra-Thomé, Dóris Firmino Rabelo, Dandara Ramos, and Emanuelle Freitas Góes
Springer International Publishing
Daiane Borges Machado, Júlia Moreira Pescarini, Dandara Ramos, Renato Teixeira, Rafael Lozano, Vinicius Oliveira de Moura Pereira, Cimar Azeredo, Rômulo Paes-Sousa, Deborah Carvalho Malta, and Mauricio L. Barreto
Springer Science and Business Media LLC
AbstractBackgroundMeasuring the Global Burden of Disease (GBD) has been the key to verifying the evolution of health indicators worldwide. We analyse subnational GBD data for Brazil in order to monitor the performance of the Brazilian states in the last 28 years on their progress towards meeting the health-related SDGs.MethodsAs part of the GBD study, we assessed the 41 health-related indicators from the SDGs in Brazil at the subnational level for all the 26 Brazilian states and the Federal District from 1990 to 2017. The GBD group has rescaled all worldwide indicators from 0 to 100, assuming that for each one of them, the worst value among all countries and overtime is 0, and the best is 100. They also estimate the overall health-related SDG index as a function of all previously estimated health indicators and the SDI index (Socio-Demographic Index) as a function of per capita income, average schooling in the population aged 15 years or over, and total fertility rate under the age of 25 (TFU25).ResultsFrom 1990 to 2017, most subnational health-related SDGs, the SDG and SDI indexes improved considerable in most Brazilian states. The observed differences in SDG indicators within Brazilian states, including HIV incidence and health worker density, increased over time. In 2017, health-related indicators that achieved good results globally included the prevalence of child wasting, NTD, household air pollution, conflict mortality, skilled birth attendance, use of modern contraceptive methods, vaccine coverage, and health worker density, but poor results were observed for child overweight and homicide rates. The high rates of overweight, alcohol consumption, and smoking prevalence found in the historically richest regions (i.e., the South and Southeast), contrast with the high rates of tuberculosis, maternal, neonatal, and under-5 mortality and WASH-related mortality found in the poorer regions (i.e., the North and Northeast).ConclusionsThe majority of Brazil’s health-related SDG indicators have substantially improved over the past 28 years. However, inequalities in health among the Brazilian states and regions remain noticeable negatively affecting the Brazilian population, which can contribute to Brazil not achieving the SDG 2030 targets.
Deise Maria Leal Fernandes Mendes and Dandara de Oliveira Ramos
FapUNIFESP (SciELO)
Abstract Mothers’ and fathers’ conceptualizations of joy, sadness, anger, fear, pride and shame were assessed. Their beliefs regarding the importance of children’s manifestation of those emotions and the connection with the profiles of autonomy, relatedness and related-autonomy were also assessed. Sixty mother- father dyads with children up to three years old participated in the study. Questionnaires of parents’ conceptualizations of emotions were used. Most participants considered joy an important emotion to be manifested by children of their kids’ age (with an individual character motivation). However, anger, pride and shame were associated with older children. Mothers’ and fathers’ conceptualizations and beliefs were not divergent. The autonomous-related self model correlated positively with the importance mothers and parents attributed to all studied emotions.
Rafael Tavares Jomar, Dandara de Oliveira Ramos, Vitor Augusto de Oliveira Fonseca, and Washington Leite Junger
Informa UK Limited
Abstract Objective: The objective of this study was to estimate the effect of the Brazilian zero-tolerance drinking and driving law on mortality rates due to road traffic accidents according to the type of victim, sex, and age. Methods: An interrupted time series design was used to compare yearly mortality rates due to road traffic accidents in Rio de Janeiro, Brazil, before and after the zero-tolerance drinking and driving law came into effect on June 19, 2008. Yearly mortality rates were compared according to the type of victim: pedestrian, cyclist, motorcyclist, and vehicle occupant. We used the Prais-Winsten procedure of autoregression in the analysis of time series; the outcome of this analysis was the annual percentage change in the rates. Overall and stratified analyses were conducted to investigate whether the zero-tolerance drinking and driving law may have had a distributional effect on mortality rates due to road traffic accidents depending on sex and age group; a significance level of P < .01 was accepted. Results: From 1999 to 2016, there were 15,629 deaths due to road traffic accidents in Rio de Janeiro. The effect of the zero-tolerance drinking and driving law on overall mortality rates due to road traffic accidents in Rio de Janeiro was not statistically significant. However, among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes and aged ≥20 years, the effect of the zero-tolerance drinking and driving law was to decrease mortality due to road traffic accidents at a yearly rate. Conclusion: There is evidence of reduced mortality rates due to road traffic accidents among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes aged ≥20 years in the second major Brazilian capital 9 years after the zero-tolerance drinking and driving law was adopted.
M Sanni Ali, Maria Yury Ichihara, Luciane Cruz Lopes, George C.G. Barbosa, Robespierre Pita, Roberto Perez Carreiro, Djanilson Barbosa dos Santos, Dandara Ramos, Nivea Bispo, Fabiana Raynal,et al.
Frontiers Media SA
Health technology assessment (HTA) is the systematic evaluation of the properties and impacts of health technologies and interventions. In this article, we presented a discussion of HTA and its evolution in Brazil, as well as a description of secondary data sources available in Brazil with potential applications to generate evidence for HTA and policy decisions. Furthermore, we highlighted record linkage, ongoing record linkage initiatives in Brazil, and the main linkage tools developed and/or used in Brazilian data. Finally, we discussed the challenges and opportunities of using secondary data for research in the Brazilian context. In conclusion, we emphasized the availability of high quality data and an open, modern attitude toward the use of data for research and policy. This is supported by a rigorous but enabling legal framework that will allow the conduct of large-scale observational studies to evaluate clinical, economical, and social impacts of health technologies and social policies.
M Sanni Ali, Daniel Prieto-Alhambra, Luciane Cruz Lopes, Dandara Ramos, Nivea Bispo, Maria Y. Ichihara, Julia M. Pescarini, Elizabeth Williamson, Rosemeire L. Fiaccone, Mauricio L. Barreto,et al.
Frontiers Media SA
Randomized clinical trials (RCT) are accepted as the gold-standard approaches to measure effects of intervention or treatment on outcomes. They are also the designs of choice for health technology assessment (HTA). Randomization ensures comparability, in both measured and unmeasured pretreatment characteristics, of individuals assigned to treatment and control or comparator. However, even adequately powered RCTs are not always feasible for several reasons such as cost, time, practical and ethical constraints, and limited generalizability. RCTs rely on data collected on selected, homogeneous population under highly controlled conditions; hence, they provide evidence on efficacy of interventions rather than on effectiveness. Alternatively, observational studies can provide evidence on the relative effectiveness or safety of a health technology compared to one or more alternatives when provided under the setting of routine health care practice. In observational studies, however, treatment assignment is a non-random process based on an individual’s baseline characteristics; hence, treatment groups may not be comparable in their pretreatment characteristics. As a result, direct comparison of outcomes between treatment groups might lead to biased estimate of the treatment effect. Propensity score approaches have been used to achieve balance or comparability of treatment groups in terms of their measured pretreatment covariates thereby controlling for confounding bias in estimating treatment effects. Despite the popularity of propensity scores methods and recent important methodological advances, misunderstandings on their applications and limitations are all too common. In this article, we present a review of the propensity scores methods, extended applications, recent advances, and their strengths and limitations.