Abstract
BackgroundPoor diet is a leading risk factor for cardiometabolic disease (CMD) in the United States, but its economic costs are unknown. We sought to estimate the cost associated with suboptimal diet in the US.Methods and findingsA validated microsimulation model (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends [CVD PREDICT]) was used to estimate annual cardiovascular disease (fatal and nonfatal myocardial infarction, angina, and stroke) and type 2 diabetes costs associated with suboptimal intake of 10 food groups (fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats, sodium). A representative US population sample of individuals aged 35–85 years was created using weighted sampling from National Health And Nutrition Examination Surveys (NHANES) 2009–2012 cycles. Estimates were stratified by cost type (acute, chronic, drug), sex, age, race, education, BMI, and health insurance. Annual diet-related CMD costs were $301/person (95% CI $287–$316). This translates to $50.4 billion in CMD costs (18.2% of total) for the whole population, of which 84.3% are attributed to acute care ($42.6 billion). The largest annual per capita costs are attributed to low consumption of nuts/seeds ($81; 95% CI $74–$86) and seafood omega-3 fats ($76; 95% CI $70–$83), and the lowest are attributed to high consumption of red meat ($3; 95% CI $2.8–$3.5) and polyunsaturated fats ($20; 95% CI $19–$22). Individual costs are highest for men ($380), those aged ≥65 years ($408), blacks ($320), the less educated ($392), and those with Medicare ($481) or dual-eligible ($536) insurance coverage. A limitation of our study is that dietary intake data were assessed from 24-hour dietary recall, which may not fully capture a diet over a person's life span and is subject to measurement errors.ConclusionsSuboptimal diet of 10 dietary factors accounts for 18.2% of all ischemic heart disease, stroke, and type 2 diabetes costs in the US, highlighting that timely implementation of diet policies could address these health and economic burdens.
Highlights
Suboptimal diet of 10 dietary factors accounts for 18.2% of all ischemic heart disease, stroke, and type 2 diabetes costs in the US, highlighting that timely implementation of diet policies could address these health and economic burdens
The highest percentage of individuals with optimal consumption were found for sugar-sweetened beverage (SSB) (48.1%), red meat (35.7%), and processed meat (32.1%), whereas the lowest were for whole grains (0.7%), sodium (2.4%), and vegetables (7.9%)
Chronic, drug-related, and total costs of cardiometabolic disease (CMD) related to a suboptimal diet and stratified by the 10 food/nutrient groups were estimated in a 1-year period
Summary
Suboptimal diet is one of the leading risk factors for poor health, both globally [1] and in the US, and is responsible for up to 45% of all cardiometabolic disease (CMD) deaths [2, 3]. Such information would strongly reinforce, from an economic perspective, priorities in public health planning and incentives for pursuing specific strategies to change unhealthy dietary habits and reduce the cardiometabolic health–related costs To address these gaps in knowledge, we used a microsimulation model—the Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends (CVD PREDICT) [10]—to estimate the annual cardiometabolic costs related to suboptimal intakes of 10 dietary factors (fruits, vegetables, nuts/ seeds, whole grains, unprocessed red meats, processed meats, SSBs, polyunsaturated fats, seafood omega-3 fats, and sodium), individually and jointly, among US adults; to assess diet-associated costs by CMD cost type (acute, chronic and drug-related); and to evaluate differences by key population subgroups (age, sex, race, education, and insurance status). We sought to estimate the cost associated with suboptimal diet in the US
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