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

Abstract

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 polic...

Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation

“…A recent analysis by our group used the US IMPACT model to compare the mortality effects of fruit and vegetable media health promotion campaigns vs. price policies on CVD mortality, finding that pricing policies had larger effects and were also more equitable for benefits by race. 31 While assessment of cost and cost-effectiveness were beyond the scope of the present investigation, a recent cost-effectiveness analysis by Basu and colleagues estimated that, for SNAP participants, raising the price of SSBs would offer a substantial benefit for health and a net cost savings from lower healthcare utilization, while a produce subsidy would have more modest impacts. 33 The six distinct policy interventions provide new evidence on an array of options with complementary tradeoffs between political feasibility, national mortality impact, and effects on disparities.…”

“…7, 12–13, 31 We modeled the impact of subsidies alone (on fruits, vegetables, nuts, whole grains), or these subsidies plus additional taxes (on SSBs and processed meat); and at nationwide levels alone, or at nationwide levels plus additional SNAP-specific incentives. The resulting 6 interventions are shown in Table 1.…”

Predictors of Farmers’ Market Shopping among People Receiving Supplemental Nutrition Assistance Program Benefits

“…These programs represent a behavioral economic approach to motivate FM use by providing a small financial incentive to reduce the costs of purchasing fruits and vegetables. There is strong evidence that healthy food incentive programs result in improvements in diet (Afshin et al., ; Pearson‐Stuttard et al., ). In the present study, participants had low levels of awareness of the healthy food incentive program that had been available in the study community for at least 4 years prior to data collection (Cleveland‐Cuyahoga County Food Policy Coalition, ).…”

Food Deserts

“…9 Modest universal reductions in fruit and vegetable prices (10% subsidy) seemed to reduce CVD mortality, and furthermore, a 30% fruit and vegetable subsidy offered to SNAP participants seemed most promising in reducing disparities. 9 Neighborhood effects can go beyond food deserts also. A large burden of CVDs can be prevented through lifestyle changes, such as tobacco avoidance, engaging in physical activity, and maintaining a healthy weight.…”