Background-Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17%of national health expenditures. As the population ages, these costs are expected to increase substantially. Methods and Results-To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other
Accounting models provide less precise estimates of disease burden than do econometric models. The authors seek to improve these estimates for cardiovascular disease using a nationally representative survey and econometric modeling to isolate the proportion of medical expenditures attributable to four chronic cardiovascular diseases: stroke, hypertension, congestive heart failure, and other heart diseases. Approximately 17% of all medical expenditures, or $149 billion annually, and nearly 30% of Medicare expenditures are attributable to these diseases. Of the four diseases, hypertension accounts for the largest share of prescription expenditures across payers and the largest share of all Medicaid expenditures. The large number of people with cardiovascular disease who are eligible for both Medicare and Medicaid could lead to large shifts in the burden to these payers as prescription drug coverage is included in Medicare. A societal perspective is important when describing the economic burden of cardiovascular disease.
Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.
T he leading cause of death in the United States today is cardiovascular disease (CVD), 1 and 45% of these deaths are attributable to high blood pressure (BP).2 Hypertension affects one third of the US adult population. Half of all adults with hypertension do not have their BP well controlled, and almost 40% of those adults are not even aware that they have hypertension.3 Failure to control hypertension has motivated international, federal, state, and local efforts to identify population-based strategies to tackle this problem. Reduction in dietary sodium intake is one such strategy.High daily sodium intake-averaging ≈3600 mg/d-has persisted in the United States for at least 20 years, 4 with 80% of intake coming from processed and commercially prepared foods rather than salt added at the point of consumption or during in-home food preparation.5 Fewer than 12% of US adults meet the current recommended standard for sodium intake.6 Observational studies have shown strong positive associations between higher sodium intake and elevated BP, and randomized, controlled trials (RCTs) of modest reductions in sodium intake have found that reductions in dietary sodium can result in significant decreases in BP. Direct evidence of the relationship of sodium intake and CVD events and indicators, including stroke and heart failure, has been found in some but not all observational studies. 7-11 Observational follow-up of the Trials of Hypertension Prevention (TOHP) found a 25% (95% confidence interval [CI], 1-43) reduction in CVD end points in long-term follow-up among those randomized to the reduced sodium arm compared with those in the control arm. 12The impacts of sodium on BP, CVD, and mortality, as well as strategies to reduce population sodium consumption, are current priorities for the Centers for Disease Control and Prevention. 13 Published estimates of the impact of populationbased sodium reduction interventions use different modeling Abstract-Computer simulations have been used to estimate the mortality benefits from population-wide reductions in dietary sodium, although comparisons of these estimates have not been rigorously evaluated. We used 3 different approaches to model the effect of sodium reduction in the US population over the next 10 years, incorporating evidence for direct effects on cardiovascular disease mortality (method 1), indirect effects mediated by blood pressure changes as observed in randomized controlled trials of antihypertension medications (method 2), or epidemiological studies (method 3).The 3 different modeling approaches were used to model the same scenarios: scenario A, gradual uniform reduction totaling 40% over 10 years; scenario B, instantaneous 40% reduction in sodium consumption sustained for 10 years to achieve a population-wide mean of 2200 mg/d; and scenario C, instantaneous reduction to 1500 mg sodium per day sustained for 10 years. All 3 methods consistently show a substantial health benefit for reductions in dietary sodium under each of the 3 scenarios tested. A gradual reduction...
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