The impact of a randomized cash transfer intervention on mortality of adult household members in rural South Africa, 2011-2022

Molly Rosenberg; Erika Beidelman; Xiwei Chen; David Canning; Lindsay Kobayashi; Kathleen Kahn; Audrey Pettifor; Chodziwadziwa Whiteson Kabudula

doi:10.1016/j.socscimed.2023.115883

The impact of a randomized cash transfer intervention on mortality of adult household members in rural South Africa, 2011-2022

Soc Sci Med. 2023 May:324:115883. doi: 10.1016/j.socscimed.2023.115883. Epub 2023 Mar 31.

Authors

Molly Rosenberg¹, Erika Beidelman², Xiwei Chen³, David Canning⁴, Lindsay Kobayashi⁵, Kathleen Kahn⁶, Audrey Pettifor⁷, Chodziwadziwa Whiteson Kabudula⁸

Affiliations

¹ Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: rosenmol@indiana.edu.
² Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
³ Biostatistics Consulting Center, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
⁴ Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁵ Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, MI, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
⁷ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
⁸ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Increasing socioeconomic resources through cash transfer payments could help promote healthy longevity. However, research in this area is limited due to endogeneity in cash transfer exposures and limited geographic representation.

Methods: We leveraged the HPTN 068 randomized cash transfer trial, conducted from 2011 to 2015 in a rural setting in South Africa. We assessed long-term mortality follow-up (until March 2022) on older adult members (n = 3568) of households enrolled in the trial from the complete Agincourt Health and socio-Demographic Surveillance System census of the underlying source population. The trial intervention was a monthly cash payment of 300 Rand conditional on school enrollment of index young women. The payments were split between the young woman (1/3) and their caregiver (2/3). Young women and their households were randomized 1:1 to intervention vs. control. We used Cox PH models to compare mortality rates in older adults living in intervention vs. control households.

Findings: The cash transfer intervention did not significantly impact mortality in the full sample [HR (95% CI): 0.94 (0.80, 1.10)]. However, we observed strong protective effects of the cash transfer intervention among those with above-median household assets [HR (95% CI): 0.66 (0.50, 0.86)] and higher educational attainment [HR (95% CI): 0.37 (0.15, 0.93)].

Interpretation: Our findings indicate that short-term cash transfers can lead to reduced mortality in certain subgroups of older adults with higher baseline socioeconomic status. Future work should focus on understanding the optimal timing, structure, and targets to maximize the benefits of cash transfer programs in promoting healthy aging and longevity.

Trial registration: ClinicalTrials.gov NCT01233531.

Keywords: Aging; Cash transfer; Income; Mortality; Older adults; South Africa.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Family Characteristics*
Female
Humans
South Africa / epidemiology
Students*

Associated data

ClinicalTrials.gov/NCT01233531

Abstract

Publication types

MeSH terms

Associated data

Grants and funding