Abstract
Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known.Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam.Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections.Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively.Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.
Highlights
Hypertension is the single largest risk factor for cardiovascular disease (CVD), the leading cause of death of globally [1]
The majority of affected people are in the low-income and middle-income countries (LMIC), where increasing trends in age-standardised mean systolic blood pressures (SBP) have been found [2]
Data on relative risks as well as baseline epidemiological data for stroke in Vietnam were obtained from the Global Burden of Disease (GBD) 2019 study [18]
Summary
Hypertension is the single largest risk factor for cardiovascular disease (CVD), the leading cause of death of globally [1]. A global synthesis of national population-based surveys found that the number of people with hypertension has more than doubled over the last four decades, with an estimated 1.1 billion people with the condition in 2015 [2]. In Vietnam, a recent systematic review of population-based studies of measured hypertension revealed that over one in five (21.1%) adults had hypertension [3]. Using a broader definition including measured SBP ≥ 140/90 mmHg and/or selfreport physician diagnosed and/or currently on blood pressure lowering medication, the national WHO STEPS survey reported a prevalence of 30.6% in 30–69-year-old adults [4]. A significant proportion of people with hypertension in Vietnam are undiagnosed, with studies reporting low awareness, treatment, and control rates [5, 6]
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