Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders

Abstract

Background: There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI programs, and the shift from TGR to MUIC as the main indicator of IDDs complicates assessment of progress. Methods: We used a novel approach to estimate the impact of USI on IDDs, applying a regression model derived from observational data on the relationship between the TGR and the MUIC from 24 countries. The model was used to generate hypothetical national TGR values for 2019 based on current MUIC data. TGR in 1993 and modeled TGR in 2019 were then compared for 139 countries, and using consequence modeling, the potential health and economic benefits realized between 1993 and 2019 were estimated. Results: Based on this approach, the global prevalence of clinical IDDs (as assessed by the TGR) fell from 13.1% to 3.2%, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%). USI has significantly reduced the number of newborns affected by IDDs, with 20.5 million cases prevented annually. The resulting improvement in cognitive development and future earnings suggest a potential global economic benefit of nearly $33 billion. However, 4.8 million newborns will be affected by IDDs in 2019, who will experience lifelong productivity losses totaling a net present value of $12.5 billion. Conclusions: The global improvements in iodine status over the past 25 years have resulted in major health and economic benefits, mainly in low-and middle-income countries. Efforts should now focus on sustaining this achievement and expanding USI to reach the continuing large number of infants who remain unprotected from IDDs.

Iodoprophylaxis and thyroid autoimmunity: an update

“…Iodine supplementation through salt iodization, implemented by the WHO and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD, now Iodine Global Network), is a worldwide, effective strategy for preventing iodine deficiency-related problems. Its safety and efficacy profile has been extensively investigated, and benefits far outweigh the potential iodine-induced risks [ 17 , 18 ]. Iodine prophylaxis through iodized salt has been shown to modulate the pattern of thyroid diseases and also to exert a pivotal role in abating iodine deficiency disorders (IDD) [ 19 , 20 ].…”

Role of Supplementations of Combined Vitamins with Minerals on Iodine Status in Pregnant Women in Bulgaria

“…The thyroid size is a very useful indicator for assessing the severity of iodine deficiency, but it is also used to control the initiation of a preventive strategy for control of iodine deficiency [30]. Our result showed that the average thyroid volume for the whole group of pregnant women was 8.94±2.62 mL, median 8.65 (minimum 0.26 -maximum 23.04).…”

Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys

“…To minimize the impact of IDD, the adoption of universal salt iodization (USI) program is recommend in all countries and there has been major global progress to the elimination of IDDs [ 13 ]. For instance, the global prevalence of clinical IDDs fell from 13.1% in 1993 to 3.2% in 2019, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%) [ 14 ] and the proportion of households consuming iodized salt increased from 70% in 2000 to 88% in 2019 low-income countries [ 13 ]. Although this substantial progress has been made over the last several decades towards iodized salt consumption, still it is under the recommendation of the World Health Organization(at least 90% of households should consume iodized salt) [ 8 ] and hence, iodine deficiency remains a significant health problem in developing countries [ 15 ].…”