did not reach statistical significanceP = 0.5369
While there was a large difference between cohort design studies (RR = 0.75, 95% CI 0.31–1.83) and before–after (RR = 0.45, 95% CI 0.39–0.53) and controlled studies (RR = 0.49, 95% CI 0.31–0.73), these differences did not reach statistical significance ( P = 0.5369), in large part because of the imprecision of the cohort study effect size.