Deaths Prevented Or Postponed Research Articles

Modelling the impact of sodium intake on cardiovascular disease mortality in Mexico

BackgroundCardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model.MethodsThe Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an “optimistic” reduction of 30%; and (c) an “intermediate” reduction of 10%.ResultsThe results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke.ConclusionsThe results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed.

Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland?

BackgroundSocioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland.MethodsThe 2010–2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations.ResultsAmong men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010–2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index).ConclusionsSignificant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.

Quantifying benefits of the Danish transfat ban for coronary heart disease mortality 1991-2007: Socioeconomic analysis using the IMPACTsec model.

Denmark has experienced a remarkable reduction in CVD mortality over recent decades. The scale of the health contribution from the Danish regulation on industrially produced trans fatty acid (ITFA) has therefore long been of interest. Thus the objective was to determine health and equity benefits of the Danish regulation on ITFA content in Danish food, by quantifying the relative contributions of changes in ITFA intake, other risk factors and treatments on coronary heart disease (CHD) mortality decline from 1991 to 2007 in Denmark, stratified by socioeconomic group. To evaluate the effects of the ITFA ban (Danish Order no. 160 of March 2003) the Danish IMPACTSEC model was extended to quantify reductions in CHD deaths attributable to changes in ITFA (%E) intake between 1991-2007. Population counts were obtained from the Danish Central Office of Civil Registration, financial income from Statistics Denmark and ITFA intake from Dan-MONICA III (1991) and DANSDA (2005-2008). Participants were adults aged 25-84 years living in Denmark in 1991 and 2007, stratified by socioeconomic quintiles. The main outcome measure was CHD deaths prevented or postponed (DPP). Mean energy intake from ITFA was decimated between 1991 and 2007, falling from 1.1%E to 0.1%E in men and from 1·0%E to 0·1%E in women. Approximately 1,191 (95% CI 989-1,409) fewer CHD deaths were attributable to the ITFA reduction, representing some 11% of the overall 11,100 mortality fall observed in the period. The greatest attributable mortality falls were seen in the most deprived quintiles. Adding ITFA data to the original IMPACTsec model improved the overall model fit from 64% to 73%. In conclusion: Denmark's mandatory elimination of ITFA accounted for approximately 11% of the substantial reduction in CHD deaths observed between 1991 and 2007. The most deprived groups benefited the most, thus reducing inequalities. Adopting the Danish ITFA regulatory approach elsewhere could substantially reduce CHD mortality while improving health equity.

Explaining the fall in Coronary Heart Disease mortality in the Republic of Ireland between 2000 and 2015 - IMPACT modelling study

BackgroundTo investigate the contribution of individual and population factors to Coronary Heart Disease (CHD) mortality rates in Ireland between 2000 and 2015. MethodsThe Irish IMPACT CHD model was utilized with CHD Deaths Prevented or Postponed (DPPs) as outcome. ResultsCHD mortality rates in Ireland in those aged 25–84 years fell by 56% (63% in women vs. men 53%), with 4060 fewer deaths than expected in 2015.Improvements in CHD risk factors explained ~30% of the decline (785 DPPs in men; 425 in women): [population systolic blood pressure (+25% DPPs), mean cholesterol serum levels (+11%) and smoking prevalence (+5%)]. Additional deaths attributable to rises in diabetes prevalence (−6%), BMI (−4%) and physical inactivity (−2%) negatively impacted DPPs.Increased uptake of cardiology treatments explained ~60% of the decline (1620 DPPs in men; 825 in women), particularly secondary prevention and heart failure treatments. Some 10% was unexplained. ConclusionCHD mortality declined in Ireland between 2000 and 2015, with two-thirds attributable to increased uptake in cardiology treatments and only one-third to improvements in population risk factors, partly reflecting adverse trends in obesity, diabetes and physical inactivity. Additional investments in prevention policies and treatments will be necessary to reduce future CHD deaths.

Impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease

Abstract Background The post-Brexit agricultural regime represents an opportunity to positively influence food systems and improve public health. Health-improving measures could include expanding the UK production of fruits and vegetables (F&amp;V), thus increasing F&amp;V availability. Currently, only 1.4% of total agricultural land in England is allocated to F&amp;V. This study aims to estimate the potential impacts of allocating additional land to F&amp;V production on cardiovascular disease (CVD) and inequalities in England between 2021 and 2030. Methods We used the previously validated IMPACT Food Policy model to translate changes in land allocated to F&amp;V into changes in F&amp;V intake and associated CVD mortality, expressed in number of deaths prevented or postponed (DPPs) by age, sex, and Index of Multiple Deprivation (IMD) quintile. We modelled two scenarios that assumed a linear increase in agricultural land allocated to F&amp;V until it covers a) 10% and b) 20% of all land suitable for production of horticultural crops in England. We assumed that F&amp;V prices would drop to a new equilibrium. We used Monte Carlo simulations to produce uncertainty intervals. Results Our model suggested that by 2030, F&amp;V intake might increase by approximately 4% (95% Uncertainty Interval: 2%-7%) and 8% (4%-13%) respectively, under the first scenario. Under the second scenario, F&amp;V intake could increase by approximately 17% (10%-29%) and 37% (26%-51%) respectively. These increases in F&amp;V intake were associated with 3360 (1760-5920) CVD DPPs under the first scenario and 15700 (9000-24310) under the second scenario in 2021-2030. Our modelled scenarios could also reduce inequalities, with some 16% of DPPs occurring in the least deprived group compared with 22% in the most deprived. Conclusions Policymakers should consider the public health impacts of the post-Brexit agricultural regime in England. Increasing the land allocated to F&amp;V production could substantially reduce the burden of CVD and associated inequalities. Key messages The post-Brexit agricultural policy can be an opportunity to improve diet and public health in the UK. Increasing the agricultural land allocated to fruit and vegetable production in England could reduce the burden of cardiovascular disease and associated inequalities.

Explaining trends in coronary heart disease mortality in different socioeconomic groups in Denmark 1991-2007 using the IMPACTSEC model.

AimTo quantify the contribution of changes in different risk factors population levels and treatment uptake on the decline in CHD mortality in Denmark from 1991 to 2007 in different socioeconomic groups.DesignWe used IMPACTSEC, a previously validated policy model using data from different population registries.ParticipantsAll adults aged 25–84 years living in Denmark in 1991 and 2007.Main outcome measureDeaths prevented or postponed (DPP).ResultsThere were approximately 11,000 fewer CHD deaths in Denmark in 2007 than would be expected if the 1991 mortality rates had persisted. Higher mortality rates were observed in the lowest socioeconomic quintile. The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic quintile. Overall, the IMPACTSEC model explained nearly two thirds of the decline in. Improved treatments accounted for approximately 25% with the least relative mortality reduction in the most deprived quintile. Risk factor improvements accounted for approximately 40% of the mortality decrease with similar gains across all socio-economic groups. The 36% gap in explaining all DPPs may reflect inaccurate data or risk factors not quantified in the current model.ConclusionsAccording to the IMPACTSEC model, the largest contribution to the CHD mortality decline in Denmark from 1991 to 2007 was from improvements in risk factors, with similar gains across all socio-economic groups. However, we found a clear socioeconomic trend for the treatment contribution favouring the most affluent groups.

Explaining the decline in coronary heart disease mortality rates in the Slovak Republic between 1993-2008.

ObjectiveBetween the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008.MethodsWe identified, obtained and scrutinised the data required for the model. These data detailed trends in the major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics (National Health Information Centre and Statistical Office of the Slovak Republic) and national representative studies (AUDIT, SLOVAKS, SLOVASeZ, CINDI, EHES, EHIS). The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence-based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs) attributable to risk factor changes or treatments. Uncertainties were explored using sensitivity analyses.ResultsBetween 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic (SR) decreased by 23% in men and 26% in women aged 25–74 years. This represented some 1820 fewer CHD deaths in 2008 than expected if mortality rates had not fallen. The IMPACT model explained 91% of this mortality decline. Approximately 50% of the decline was attributable to changes in acute phase and secondary prevention treatments, particularly acute and chronic treatments for heart failure (≈12%), acute coronary syndrome treatments (≈9%) and secondary prevention following AMI and revascularisation (≈8%). Changes in CHD risk factors explained approximately 41% of the total mortality decrease, mainly reflecting reductions in total serum cholesterol. However, other risk factors demonstrated adverse trends and thus generated approximately 740 additional deaths.ConclusionOur analysis suggests that approximately half the CHD mortality fall recently observed in the SR may be attributable to the increased use of evidence-based treatments. However, the adverse trends observed in all the major cardiovascular risk factors (apart from total cholesterol) are deeply worrying. They highlight the need for more energetic population-wide prevention policies such as tobacco control, reducing salt and industrial trans fats content in processed food, clearer food labelling and regulated marketing of processed foods and sugary drinks.

Reducing US cardiovascular disease burden and disparities through national and targeted dietary policies: A modelling study.

BackgroundLarge socio-economic disparities exist in US dietary habits and cardiovascular disease (CVD) mortality. While economic incentives have demonstrated success in improving dietary choices, the quantitative impact of different dietary policies on CVD disparities is not well established. We aimed to quantify and compare the potential effects on total CVD mortality and disparities of specific dietary policies to increase fruit and vegetable (F&V) consumption and reduce sugar-sweetened beverage (SSB) consumption in the US.Methods and findingsUsing the US IMPACT Food Policy Model and probabilistic sensitivity analyses, we estimated and compared the reductions in CVD mortality and socio-economic disparities in the US population potentially achievable from 2015 to 2030 with specific dietary policy scenarios: (a) a national mass media campaign (MMC) aimed to increase consumption of F&Vs and reduce consumption of SSBs, (b) a national fiscal policy to tax SSBs to increase prices by 10%, (c) a national fiscal policy to subsidise F&Vs to reduce prices by 10%, and (d) a targeted policy to subsidise F&Vs to reduce prices by 30% among Supplemental Nutrition Assistance Program (SNAP) participants only. We also evaluated a combined policy approach, combining all of the above policies. Data sources included the Surveillance, Epidemiology, and End Results Program, National Vital Statistics System, National Health and Nutrition Examination Survey, and published meta-analyses.Among the individual policy scenarios, a national 10% F&V subsidy was projected to be most beneficial, potentially resulting in approximately 150,500 (95% uncertainty interval [UI] 141,400–158,500) CVD deaths prevented or postponed (DPPs) by 2030 in the US. This far exceeds the approximately 35,100 (95% UI 31,700–37,500) DPPs potentially attributable to a 30% F&V subsidy targeting SNAP participants, the approximately 25,800 (95% UI 24,300–28,500) DPPs for a 1-y MMC, or the approximately 31,000 (95% UI 26,800–35,300) DPPs for a 10% SSB tax.Neither the MMC nor the individual national economic policies would significantly reduce CVD socio-economic disparities. However, the SNAP-targeted intervention might potentially reduce CVD disparities between SNAP participants and SNAP-ineligible individuals, by approximately 8% (10 DPPs per 100,000 population). The combined policy approach might save more lives than any single policy studied (approximately 230,000 DPPs by 2030) while also significantly reducing disparities, by approximately 6% (7 DPPs per 100,000 population).Limitations include our effect estimates in the model; these estimates use interventional and prospective observational studies (not exclusively randomised controlled trials). They are thus imperfect and should be interpreted as the best available evidence. Another key limitation is that we considered only CVD outcomes; the policies we explored would undoubtedly have additional beneficial effects upon other diseases. Further, we did not model or compare the cost-effectiveness of each proposed policy.ConclusionsFiscal strategies targeting diet might substantially reduce CVD burdens. A national 10% F&V subsidy would save by far the most lives, while a 30% F&V subsidy targeting SNAP participants would most reduce socio-economic disparities. A combined policy would have the greatest overall impact on both mortality and socio-economic disparities.

Reduction of cardiovascular disease inequalities in the USA through dietary policy

BackgroundThe burden of cardiovascular disease mortality remains large and unequal in the USA, and is mostly attributable to poor diet. Few data exist about the potential population level impact on inequalities of policies to improve diet such as the Supplemental Nutrition Assistance Program (SNAP). We aimed to estimate reductions in cardiovascular disease mortality and inequalities achievable in the US population up to 2030 through dietary policies. MethodsWe developed a US IMPACT (International Model for Policy Analysis of Agricultural Commodities and Trade) food policy model to estimate the number of deaths prevented or postponed (DPPs) achievable with four feasible scenarios that have been successfully implemented across the world: a national fruit and vegetables and sugar-sweetened beverage mass media campaign, fruit and vegetable price reductions of 10% universally and 30% to SNAP participants, and universal sugar-sweetened beverage price increase of 10%. We further modelled a combination of these policies. We stratified the US population by SNAP eligibility and participation. We estimated number of deaths using the incremental effect of each policy upon the target food groups. Then we estimated the effect upon cardiovascular disease mortality compared with existing baseline of continued trends. Probabilistic sensitivity analyses were conducted. FindingsA universal 10% price reduction of fruit and vegetables could prevent the most deaths—about 150 500 DPPs by 2030 (95% CI 137 800–160 500). This compares with approximately 23 000 DPPs (21 500–24 600) generated through a 1 year mass media campaign, or 21 400 DPPs (18 200–24 500) by a 10% price increase in sugar-sweetened beverages. A 30% price reduction in fruit and vegetables for SNAP participants could result in roughly 35 100 DPPs (31 800–37 700) and also achieve the biggest reduction in inequalities between SNAP participants and the ineligible population. The combined policy approach would save most lives (about 204 800 DPPs) while also reducing inequalities. InterpretationFiscal strategies targeting diet could contribute to reduce the unequal cardiovascular mortality burden in the USA. All four dietary policies would be effective, but a combination of the universal and targeted aspects of policies would be the most effective. Individually, a universal 10% reduction in the price of fruit and vegetables might save most lives, whereas a targeted, 30% price reduction for SNAP participants could reduce inequalities the most. FundingNational Institutes of Health (grant number R01HL115189). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract.

Abstract P281: Comparing the Impact of Price Change and Mass Media Campaigns in Reducing Cardiovascular Disease Mortality and Disparities in the US

Introduction: Cardiovascular disease (CVD) mortality burdens remain large and unequal in the US, and much is attributable to poor diets. However, few data exist regarding the potential population level impact of policies aimed at improving dietary intake, such as the Supplemental Nutrition Assistance Programme (SNAP), and potential effects on disparities. Aim: To estimate reductions in CVD mortality and disparities achievable in the US population up to 2030 through food price changes and mass media campaign interventions targeting fruits and vegetables (F&amp;V) and sugar sweetened beverages (SSBs). Methods: We developed a US IMPACT Food Policy Model to compare four contrasting food policy scenarios targeting dietary intake: A) - national F&amp;V mass media campaign, B) F&amp;V price reductions of 10% universally and C) 30% to SNAP participants, D) - SSB price increase of 10% universally. Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections, and NHANES. We stratified the US population into SNAP participants, SNAP eligible but not participating, and SNAP ineligible. We modelled cumulative deaths prevented or postponed (DPP) and life years gained (LYG) using best-evidence effect sizes for each policy, existing mortality rates and trends, and F&amp;V and SSB mortality effects. We stratified by age, sex, and CVD subtype from 2015 to 2030. Sensitivity analyses were conducted with Monte Carlo simulation. Results: Scenario B (universal 10% price reduction) would yield the greatest national benefits, generating approximately 88,000 DPPs (95% CI: 81,000-94,000) and 1,369,000 LYGs (1,268,000-1,460-000) by 2030. This compares with between 28,000 (26,000-30,000) and 84,000 (79,000-89,000) DPPs in Scenario A, depending on duration of media campaigns; and approximately 27,000 (24,000-30,000) and 29,000 (25,000-33,000) DPPs in scenarios C and D respectively. Scenario C (30% price reduction to SNAP participants) might reduce CVD disparities by about 18% comparing SNAP participants with the ineligible population. Scenarios A, B and D would have negligible effects on mortality disparities. Conclusions: All four dietary policies would be effective in reducing mortality. Reducing fruit and vegetable (F&amp;V) price by 10% to the entire US would save most lives. Reducing F&amp;V price by 30% to SNAP participants would reduce disparities the most, particularly if SNAP program coverage and penetration were improved. These results support population fiscal strategies targeting diet to reduce cardiovascular mortality and disparities in the US.

OP51 Comparing the effectiveness of price reduction and mass media campaigns in reducing cvd mortality by targeting fruit and vegetables intake

Background Cardiovascular disease (CVD) mortality rates have reduced dramatically in the US, yet CVD remains accountable for approximately 800,000 deaths annually. Poor diet, including poor fruits and vegetables (F&V) intake is a leading CVD risk factor. Due to a previous lack of systemically estimated effect sizes of dietary policies and effect of dietary factors on CVD mortality, scarce data exist regarding the potential population level impact of policies aimed at increasing fruits and vegetables intake. We therefore aimed to estimate CVD mortality reductions attributable to price and mass media campaign interventions in the US population up to 2030. Methods We extended the IMPACT Food policy model to compare potential effects upon CVD mortality, of two contrasting policies targeting F&V intake. Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections and the National Health and Nutrition Examination Survey. Using US population projections to 2030 and novel best evidence effect sizes for each policy, and fruits and vegetables mortality effect size, we modelled cumulative deaths prevented or postponed (DPP), by age, gender and CVD subtype from 2015 to 2020 and 2030 under three contrasting scenarios. In SCENARIOs A and B, we model a universal price reduction of F&V by 10 and 30% respectively In SCENARIO C we model a mass media campaign across the entire US Results were tested in a probabilistic sensitivity analysis using montecarlo simulation. Results We project 890,000 CVD Deaths in 2020, rising to 1.7 million CVD deaths by 2030 if current trends continue. Scenario A could result in approximately 35,000 (95% confidence intervals 34,000–37,000) DPPs by 2020, increasing to 91,000 (87,000–95,000) by 2030 respectively. Some 62% of these attributed to CHD, and 53% in males. Scenario B could increase the gains to approximately 106,000 (99,000–112,000) DPPs by 2020, and some 270,000 (258,000–281,000) DPPs by 2030. In contrast, Scenario C could result in approximately 38,000 (36,000–40,000) DPPs by 2020, increasing to approximately 109,000 (104,000–114,000) DPPs by 2030. Conclusion Both price reduction policies (10 and 30%) and a nationwide Mass Media Campaign would be effective in reducing mortality. A 30% price reduction policy however would save more lives in the short (2020) and medium term (2030). These results support further population level and fiscal strategies to reduce CVD mortality in the US. A further cost effectiveness analysis would be of great importance to policy makers in implementing these policies.

PL01 Exploring the potential of trans fats policies to reduce socio-economic inequalities in cardiovascular disease mortality in england: a cost-effectiveness modelling study

Background Trans fatty acids (TFA) increase coronary heart disease (CHD) incidence by 11% for each 1% of dietary energy from TFA. Many countries have already taken action to reduce or eliminate TFA from processed foods. Currently the UK relies on the voluntary cooperation of industry. In this study, we determined and compared the health and equity benefits and cost effectiveness of additional, contrasting policies to reduce or eliminate TFA from processed foods in England. Methods Using the IMPACT Food Policy model, we estimated the reduction in CHD mortality and incidence in England that might result from four distinct policy options to reduce or eliminate TFA from processed foods: total legislative ban; improved labelling; bans in restaurants; or bans in take-aways. Average TFA consumption was taken from the National Diet and Nutrition Survey, and a socioeconomic gradient in TFA consumption was inferred from the Low Income Diet and Nutrition Survey. Potential reductions in TFA consumption were based on policy implementations in other countries. Health outcomes, including deaths prevented or postponed (DPP) and quality-adjusted life years (QALY), were stratified by socioeconomic circumstance using quintiles of the Index of Multiple Deprivation (IMDQ). Economic analysis considered policy costs to government and industry and savings in direct health care, informal care, and averted productivity loss. We calculated cost-effectiveness of each policy as incremental societal cost per QALY. Analyses were conducted in R software, and probabilistic sensitivity analysis was used to assess uncertainty. Results A total ban on TFA in processed foods might prevent or postpone approximately 7,200 (95% CI: 3,000–12,700) CHD deaths in England from 2015–2020 and reduce inequality in CHD mortality by some 3,000 (1,200–5,200) deaths. Policies to improve labelling or remove TFA from restaurants or take-aways could save between 1,800 and 3,500 (700–6,100) CHD deaths and reduce inequalities by 600 to 1,500 (300–2,600) deaths, thus making them less than half as effective. Any policy we evaluated would be cost effective from a total societal perspective, even if industry incurred substantial reformulation costs. A total ban would be the most cost effective, with savings of around £15,000 (£9,000–£40,000) per QALY in 2020. Conclusion The most effective and equitable policy option would be regulation to eliminate TFA from processed foods in England (as successfully achieved in various other countries). Intermediate policies would also have some benefits. However, simply continuing to rely on industry to voluntary reformulate products could have negative health and economic outcomes.

Effects of Health-Related Food Taxes and Subsidies on Mortality from Diet-Related Disease in New Zealand: An Econometric-Epidemiologic Modelling Study.

BackgroundHealth-related food taxes and subsidies may promote healthier diets and reduce mortality. Our aim was to estimate the effects of health-related food taxes and subsidies on deaths prevented or postponed (DPP) in New Zealand.MethodsA macrosimulation model based on household expenditure data, demand elasticities and population impact fractions for 18 diet-related diseases was used to estimate effects of five tax and subsidy regimens. We used price elasticity values for 24 major commonly consumed food groups in New Zealand, and food expenditure data from national Household Economic Surveys. Changes in mortality from cardiovascular disease, cancer, diabetes and other diet-related diseases were estimated.FindingsA 20% subsidy on fruit and vegetables would result in 560 (95% uncertainty interval, 400 to 700) DPP each year (1.9% annual all-cause mortality). A 20% tax on major dietary sources of saturated fat would result in 1,500 (950 to 2,100) DPP (5.0%), and a 20% tax on major dietary sources of sodium would result in 2,000 (1300 to 2,700) DPP (6.8%). Combining taxes on saturated fat and sodium with a fruit and vegetable subsidy would result in 2,400 (1,800 to 3,000) DPP (8.1% mortality annually). A tax on major dietary sources of greenhouse gas emissions would generate 1,200 (750 to 1,700) DPP annually (4.0%). Effects were similar or greater for Maori and low-income households in relative terms.ConclusionsHealth-related food taxes and subsidies could improve diets and reduce mortality from diet-related disease in New Zealand. Our study adds to the growing evidence base suggesting food pricing policies should improve population health and reduce inequalities, but there is still much work to be done to improve estimation of health impacts.

The contribution of primary prevention medication and dietary change in coronary mortality reduction in England between 2000 and 2007: a modelling study

ObjectiveTo analyse the falls in coronary heart disease (CHD) mortality in England between 2000 and 2007 and quantify the relative contributions from preventive medications and population-wide changes in blood pressure...

OP09 Coronary mortality reductions attributable to primary prevention medications versus dietary changes in Scotland 2000–2010: modelling study using routine linked data

Background Between 2000 and 2010, coronary heart disease (CHD) mortality rates in Scotland fell by over one third. Important contributions came from reductions in blood pressure and serum cholesterol (primary prevention). However, the relative contributions from preventive medications (anti-hypertensives and statins) in individuals and from population-wide dietary changes remain unclear. We therefore examined the impact of differential effects on health inequalities. Methods We used the previously validated IMPACTsec model to estimate the contributions of population-level risk factor changes and treatment changes to the CHD mortality decline in Scotland between 2000 and 2010 for adults aged over 25. Data were stratified using the Scottish Index of Multiple Deprivation (SIMD), a small area measure of deprivation. Model outputs were quantified as deaths prevented or postponed (DPPs) by each intervention. Sensitivity analyses were conducted using Ersatz-based Monte Carlo simulations. Results Between 2000 and 2010, 5770 fewer CHD deaths than expected occurred in Scotland; an estimated 3570 (62%) were attributable to reductions in blood pressure and serum cholesterol. Declines in blood pressure were responsible for approximately 2285 DPPs (minimum estimate 1630, maximum estimate 2915). The vast majority (2130 DPPs) came from population-wide blood pressure falls, with bigger absolute mortality decreases in the most deprived quintile compared with the least deprived (460 vs. 340 DPPs respectively); relative contributions were similar (37.2% and 37.5%). Anti-hypertension medications resulted in only 155 fewer deaths, with similar DPPs in the most (35) and least (30) deprived quintiles. Reductions in serum cholesterol resulted in 1280 fewer deaths; approximately 515 of these were attributable to population-wide changes in diet with more deaths prevented in the most deprived quintile compared with the least deprived (170 vs. 45 DPPs; relative contribution 13.8% and 4.7%). Conversely, approximately 770 fewer deaths were attributable to statin use, with very similar absolute numbers of deaths prevented in most (140) and least (140) deprived quintiles, but relatively greater contributions in the least deprived (15.4% vs 11.2%). Statin uptake was higher in the most deprived areas (17% vs 13.2%). Conclusion Population-wide falls in blood pressure helped to reduce CHD mortality; however the benefit from hypertension treatment was small. Improved diet and statins for high-risk individuals both made important contributions to the fall in population cholesterol. Population-wide falls in blood pressure and reductions due to medical treatments for hypertension were equitable between socio-economic groups. Higher socio-economic groups appeared to benefit more from statins, probably due to better compliance; this may perpetuate inequalities.

OP54 Explaining the decline in coronary heart disease mortality in the Slovak Republic between 1993–2008

<h3>Background</h3> Although cardiovascular diseases remain the most important cause of death in the Slovak Republic, mortality rates from coronary heart disease (CHD) have substantially decreased in the last two decades. The aim of this modelling study was therefore to try and quantify the main contributions to this mortality decline. <h3>Methods</h3> Data covering adults aged 25–74 years in the Slovak Republic (population 3.5 million) between the years 1993–2008 were identified, obtained and scrutinised. These data detailed trends in major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics, national representative studies, published trials and meta-analyses, and the Slovak CINDI studies. The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs). Uncertainties were explored using probabilistic sensitivity analyses. <h3>Results</h3> Between 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic decreased by 23% in men and 26% in women aged 25–74 years, representing 1950 fewer CHD deaths in 2008. Improvements in the uptake of evidence based treatments explained approximately 48% of the mortality fall (mainly reflecting contributions from treatments for acute coronary syndrome, acute and chronic heart failure and primary prevention, ie. statins and anti-hypertensives). Changes in CHD risk factors explained approximately 43% of the total mortality decrease (resulting mainly from positive changes in total serum cholesterol). However, most other risk factors demonstrated adverse trends and thus generated approximately 575 additional deaths. Results remained relatively stable under a range of sensitivity analyses. <h3>Conclusion</h3> This preliminary analysis suggests that approximately half the coronary heart disease mortality fall recently observed in the Slovak Republic may be attributable to evidence based treatments, with much of the remainder coming from large falls in total serum cholesterol. The adverse trends observed in all the other major cardiovascular risk factors (smoking, blood pressure, BMI, diabetes and physical inactivity) in the Slovak Republic are deeply worrying, and emphasise the need for more energetic population-wide prevention policies.

Abstract P448: Exploring Socioeconomic Inequalities In Coronary Heart Disease Prevention

Background: Between 2000 and 2007, coronary heart disease (CHD) mortality rates in England plummeted by one third. An important part of this substantial CHD mortality decline was achieved through reductions in major cardiovascular risk factors (primary prevention). However, the relative contributions from medications and from population-wide changes remains unclear, particularly the effects on health inequalities. Methods: Using a previously validated policy model, the fall in CHD mortality in England was analysed. The contributions from risk factor declines in asymptomatic individuals through medications and through population-wide changes were quantified. Data were stratified using the Index of Multiple Deprivation (IMD). Model outputs were quantified as deaths prevented or postponed (DPPs). Results: Between 2000 and 2007, approximately 21,900 fewer CHD deaths were attributable to risk factor declines in systolic blood pressure and cholesterol in the English population. Some 7,100 of these 21,900 fewer deaths (DPPs) were attributed to medications (32%) and approximately 14,800 DPPs were attributed to secular changes in asymptomatic individuals (68%). Substantial declines in systolic blood pressure were responsible for approximately 14,300 fewer deaths. This comprised approximately 12,500 DPPs attributable to population-wide changes and some 1,800 DPPs attributable to hypertension medications. The hypertension medications resulted in approximately 350 fewer deaths in the most affluent quintile compared with 270 DPP in the most deprived. In contrast, the population-wide (secular) falls in blood pressure resulted in approximately 2400 fewer deaths in the most deprived quintile compared with only 1900 DPPs in the most affluent. Cholesterol falls resulted in approximately 7,700 fewer deaths. This comprised some 5,300 fewer deaths attributable to statin medications and approximately 2,400 fewer deaths attributable to population-wide changes (mostly diet). Statin medications prevented more deaths in the most affluent quintile (1050 DPPs) compared with the most deprived (770 DPPs). Population-wide changes in cholesterol prevented substantially more deaths in the most deprived quintile (820 DPPs) compared with the most affluent (260 DPPs). Conclusions: Population-based declines in blood pressure and cholesterol resulted in much greater reductions in CHD deaths than did primary prevention medications. Mortality falls were greatest in the most deprived quintiles, mainly reflecting their bigger initial burden of disease. Future CHD prevention policies should prioritise healthier diets ahead of medications.

Abstract P069: Quantifying the UK Benefits of reducing dietary trans fats: Modelling study

Introduction: Coronary Heart Disease (CHD) disease remains a leading cause of UK mortality, generating a large and unequal burden of disease. Dietary trans-fats represent a powerful CHD risk factor. However, UK efforts to reduce the dietary intake of trans-fats (currently 1% of daily energy) have been limited in comparison with some other nations. Furthermore, quantifying the potential outcomes of such measures, and the effects on health inequalities has rarely been researched. We therefore modelled the effect of specific reductions in trans fatty acid (TFA) intake on CHD mortality, CHD related admissions and its effect on socioeconomic inequalities up to 2030. Methods: We extended the previously validated IMPACT model, to estimate the potential effects of reductions in TFA intake by 1% and 0.5% of daily energy upon the England and Wales population aged 25 years and above. We stratified these estimates by age, sex and Socioeconomic circumstances(SEC). We estimated a reduction in expected CHD deaths in 2030 attributable to a modest reduction in TF intake (-0.5% energy) and a complete ban (-1% energy). Main output measures were deaths prevented or postponed (DPP), life years gained (LYGs) and hospital admissions. Results: Reducing trans-fat consumption in the English and Welsh population by 1% of daily energy intake would result in approximately 3,900 fewer deaths per year; 10,000 fewer hospital admissions; and 37,000 additional life years. Smaller TFA reductions of 0.5% would yield approximately 1,900 fewer deaths, 5,000 fewer hospital admissions, and gain approximately 18,000 life years. Further, reducing trans-fats consumption to 0.5% across all SECs would reduce health inequalities. Three times as many DPPs and LYGs would be observed in the most deprived compared with the most affluent groups. Conclusions: Reducing dietary trans-fat intakes could substantially decrease CHD mortality and hospital admissions, gaining thousands of life years. Crucially, this policy could also reduce health inequalities. Strategies should therefore aim to achieve the lowest possible trans-fats intakes, as successfully achieved in many other European countries. However, such policies currently remain underused in the UK, generating an avoidable and unequal burden on the health services and on society.

OP54 Exploring Socioeconomic Inequalities in Coronary Heart Disease Prevention

BackgroundBetween 2000 and 2007, coronary heart disease (CHD) mortality rates in England plummeted by one third. An important part of this substantial CHD mortality decline was achieved through reductions in...

Modelling coronary heart disease mortality in Northern Ireland between 1987 and 2007

PurposeIn 1987, Northern Ireland had one of the highest rates of Coronary heart disease (CHD) mortality in the world. Despite rapidly declining CHD mortality over the last two decades, CHD...