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Public health
Research
Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study
  1. Chris Kypridemos1,
  2. Maria Guzman-Castillo1,
  3. Lirije Hyseni1,
  4. Graeme L Hickey2,
  5. Piotr Bandosz1,3,
  6. Iain Buchan4,
  7. Simon Capewell1,
  8. Martin O'Flaherty1
  1. 1Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  2. 2Department of Biostatistics, University of Liverpool, Liverpool, UK
  3. 3Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland
  4. 4Farr Institute @ HeRC, University of Manchester, Manchester, UK
  1. Correspondence to Dr Chris Kypridemos; ckyprid{at}liverpool.ac.uk

Abstract

Objective To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England.

Design A microsimulation study of a close-to-reality synthetic population. In the first period, 2003–2015, we compared the impact of current policy against a counterfactual ‘no intervention’ scenario, which assumed salt consumption persisted at 2003 levels. For 2016–2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030.

Setting Synthetic population with similar characteristics to the non-institutionalised population of England.

Participants Synthetic individuals with traits informed by the Health Survey for England.

Main measure CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation.

Results Since 2003, current salt policies have prevented or postponed ∼52 000 CVD cases (IQR: 34 000–76 000) and 10 000 CVD deaths (IQR: 3000–17 000). In addition, the current policies have prevented ∼5000 new cases of GCa (IQR: 2000–7000) resulting in about 2000 fewer deaths (IQR: 0–4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone ∼19 000 CVD cases (IQR: 8000–30 000) and 3600 deaths by 2030 (IQR: −400–8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: −200–3000) and 700 deaths (IQR: −900–2300) could be prevented or postponed with a neutral impact on inequalities.

Conclusions Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits.

  • Salt
  • Cardiovascular disease
  • Gastric Cancer
  • Public health policy
  • Microsimulation

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-013791

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    Footnotes

    • Contributors All authors made a substantial contribution to conception and design. CK, MG-C and MOF had the original idea. LH performed the literature search. CK prepared and conducted data analysis and modelling. All authors contributed to drafting the manuscript and revising it critically.

    • Funding The Health Survey for England was funded by the Department of Health until 2004 and the Health and Social Care Information Centre from 2005. IB and CK were supported by Medical Research Council Health eResearch Centre grant MR/K006665/1. SC, MOF, MGC, LH and PB were supported by the National Institute for Health Research through a grant (SPHR-LIL-PH1-MCD) to the LiLaC collaboration between the University of Liverpool and Lancaster University.

    • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

    • Ethics approval Ethical approval was not required for this study, as it is an analysis of previously collected data. Ethical approval for each survey was obtained by the Health Survey for England team.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Anonymised, non-identifiable participant-level cross-sectional survey data are freely available for academic researchers and public health staff to download from the UK Data Service. The source code of IMPACTNCD is available at https://github.com/ChristK/IMPACTncd/tree/Evaluation_of_UK_salt_strategy.