reducing us cardiovascular disease disparities through food policy · 2016-10-19 · cardiovascular...
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Reducing US cardiovascular disease disparities through food policy
Jonathan Pearson-Stuttard, Piotr Bandosz, Colin Rehm, Jose Penalvo, Laurie Whitsel, Tom Gaziano,
Ffion Lloyd-Williams, Simon, Capewell, DariushMozaffarian, Martin O’Flaherty
Universities of Liverpool, Imperial College London, Harvard & Tufts
Cardiovascular Disease• Huge burden of disease in US and globally
• Mortality rates halved over three decades
• 1.6m CVD cases annually
• 500,000 CVD deaths per year
• Projected 116 million individuals will be coping with CVD by 2030
• Unequal burden, more in deprived & ethnic minorities
Heidenreich et al Circulation 2011
Cardiovascular Disease
• Major Risk Factors:• Diet: added sugar, Fruit & Veg, Salt, Trans Fats
• Tobacco
• Excess Alcohol
• Physical Inactivity
• Potential effectiveness of F&V policies poorly documented
• Potential benefits of population level policies poorly documented
• ↑ 100g daily intake • ↓CHD mortality 1.3-6.1%
• ↓Stroke mortality 1.7-14.4%
BUT
• Potential effectiveness of F&V policies poorly documented
(particularly population level policies)
Fruits & Vegetable benefits
Khatibzadehet al Circulation 2012
Sugar Sweetened Beverages (SSB)
• Consumption falls with age:• 2.8 servings a day (young men)
• 0.4 servings a day (elderly women)
• SSB price increases successfully implemented Mexico, France, Berkeley
BUT
• Potential benefits upon disparities poorly estimated
Bartlet et al, USDA, 2014Conrad et al, in submission
• Aims to prevent food insecurity & hunger and promote diet quality
• Gives food stamps to 46million Americans
BUT
• SNAP recipients have worse cardio-metabolic health than non-eligible population
HENCE
• Healthy Incentive Pilot (HIP)• fruits & veg 30% price cheaper when purchased using EBT card
• Consumption ↑ 27%
Supplemental Nutrition Assistance Programme(SNAP)
Objective
• Estimate effect of• Price changes
• Mass Media Campaign targeting fruits, vegetables and SSB consumption
• on CVD mortality & disparities• in the USA up to 2030
• Stratified by • Age & gender
• SNAP group (proxy for socio-economic status)
Methods• Quantified the population benefits and effects upon
disparities 2015-2030 of contrasting food policiesA) NationalB) Targeting high risk groups
A+B) Combined Approach (National +Targeting high risk groups)
• Estimated cumulative Deaths Prevented or Postponed (DPP)
• Stratified by• age• Gender• SNAP group (SES proxy)• CVD subtype
Dietary policy options to address CVD and disparities?
A. National policies1. Media campaigns
2. SSB tax (10%)
3. Small subsidy on healthy foods (fruits & veg) (10%)
B. Targeted policies• Most deprived groups receive larger subsidy (30%) on healthy foods
A+B = combination of national and targeted policies
Mass Media Campaign
• Mass media campaign ↑ F&V intake by 7% (4%-11%)
Assumed:• Full effect in 2016
• Continued effect to 2030
Afshin et al, In submission
Price Reduction Policies (Subsidies)
• 10% national price reduction ↑ F&V consumption by 14% (11-17%)
Assumed:
• 50% larger effect in most deprived group v. most affluent
• Full effect in baseline year (2015)
• Effect continues to 2030
• 30% targeted price reduction ↑ F&V consumption by 27%
Afshin et al, In submission Bartlet et al, USDA, 2014
Price Increase (Tax)
• 10% national price increase ↓ SSB consumption by 7% (3-10%)
Assumed:
• 50% larger effect in most deprived v most affluent
• Full effect in baseline year (2015)
• Effect continues to 2030
Afshin et al, In submission
Food policy modelling approach
Risk Factor ChangeCVD
Mortality
ChangeFoodPolicy
↑ F&V consumption e.g.
F&V Price reduction
CVD deaths
13
Stratified by age, gender, SES & CVD
subtype
Results
Deaths averted 2015-2030(heart disease and stroke)
Deaths averted 2015-2030(heart disease and stroke)
Deaths averted 2015-2030(heart disease and stroke)
Effects onDisparities?
Types of policy?
• High risk targeted policies?
• Or
• Whole population approach?
• Or Combination
Strengths
• Considers entire US adult population (200 million)
• Reliable datasets
• Novel policy modelling of population level intervention
• Stratification by SES
• APC mortality projections may provide conservative estimates of benefits
Limitations
BUT
• Risk estimates are imperfect
• Coverage not stratified by age or gender
• Assumes instantaneous effect
• No cost estimates
Conclusions
• All policies modelled would reduce CVD mortality
• Targeted subsidy would achieve greatest reduction in disparities
• Combined approach → big reductions in mortality AND disparities
• Cost effectiveness research now required
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Reducing US cardiovascular disease disparities through food policy
Jonathan Pearson-Stuttard, Piotr Bandosz, Colin Rehm, Jose Penalvo, Laurie Whitsel, Tom Gaziano,
Ffion Lloyd-Williams, Simon, Capewell, DariushMozaffarian, Martin O’Flaherty
Thank [email protected]