Background Cardiovascular disease (CVD) mortality rates have reduced dramatically in the US, yet CVD remains accountable for approximately 800,000 deaths annually. Poor diet, including poor fruits and vegetables (F&V) intake is a leading CVD risk factor. Due to a previous lack of systemically estimated effect sizes of dietary policies and effect of dietary factors on CVD mortality, scarce data exist regarding the potential population level impact of policies aimed at increasing fruits and vegetables intake. We therefore aimed to estimate CVD mortality reductions attributable to price and mass media campaign interventions in the US population up to 2030.
Methods We extended the IMPACT Food policy model to compare potential effects upon CVD mortality, of two contrasting policies targeting F&V intake. Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections and the National Health and Nutrition Examination Survey.
Using US population projections to 2030 and novel best evidence effect sizes for each policy, and fruits and vegetables mortality effect size, we modelled cumulative deaths prevented or postponed (DPP), by age, gender and CVD subtype from 2015 to 2020 and 2030 under three contrasting scenarios.
In SCENARIOs A and B, we model a universal price reduction of F&V by 10 and 30% respectively
In SCENARIO C we model a mass media campaign across the entire US
Results were tested in a probabilistic sensitivity analysis using montecarlo simulation.
Results We project 890,000 CVD Deaths in 2020, rising to 1.7 million CVD deaths by 2030 if current trends continue. Scenario A could result in approximately 35,000 (95% confidence intervals 34,000–37,000) DPPs by 2020, increasing to 91,000 (87,000–95,000) by 2030 respectively. Some 62% of these attributed to CHD, and 53% in males. Scenario B could increase the gains to approximately 106,000 (99,000–112,000) DPPs by 2020, and some 270,000 (258,000–281,000) DPPs by 2030.
In contrast, Scenario C could result in approximately 38,000 (36,000–40,000) DPPs by 2020, increasing to approximately 109,000 (104,000–114,000) DPPs by 2030.
Conclusion Both price reduction policies (10 and 30%) and a nationwide Mass Media Campaign would be effective in reducing mortality. A 30% price reduction policy however would save more lives in the short (2020) and medium term (2030). These results support further population level and fiscal strategies to reduce CVD mortality in the US. A further cost effectiveness analysis would be of great importance to policy makers in implementing these policies.
- Cardiovascular disease
- policy modelling
- fruits and vegetables