Background Excessive salt consumption is the leading dietary risk factor for cardiovascular disease (CVD). In Brazil, 30% of salt in the diet comes from packaged foods; Government and food industries have agreed on voluntary salt reduction targets for 29 food categories since 2011. The objective of this study was to quantify the potential health and economic impacts of this policy up to the year 2032.
Methods We adapted a previously validated microsimulation approach (IMPACTNCD Model) for the Brazilian population. IMPACTNCD BR is a stochastic dynamic microsimulation model based on the simulated life courses of close-to-reality synthetic individuals under different policy scenarios, while explicitly considering population heterogeneity and lag times between exposures and outcomes. To inform model inputs, we used the data from the 2013 National Health Survey in Brazil, the 2008–2009 Household Budget Survey, public health information system data and high-quality meta-analyses, costs to the National Health System from CVD treatment and informal healthcare costs. We estimated CVD cases and deaths prevented or postponed, and disease treatment costs, assuming the food industry will retain their level of engagement with the policy in the future. IMPACTNCD BR was developed in R v3.6.1.
Results IMPACTNCD BR estimated that between 2013 and 2032, the voluntary targets could prevent or postpone approximately 180,000 CVD cases (95% Uncertainty Interval (UI): 45,000 to 425,000) and 14,000 (95% UI: 2,800 to 33,000) deaths among Brazilian adults aged 30 to 79 years. The majority of the prevented cases were among men reflecting their higher salt exposure and CVD burden. The policy may produce savings to the Brazilian National Health System of approximately US$220m (95% UI: $54m to $520m). Further US$ 70m (95% UI: $17m to $170m) might be saved in informal healthcare costs.
Conclusion Despite the modest compliance of the food industry to the Brazilian voluntary salt targets, salt reformulation in Brazil may generate substantial health and economic impacts. However, the much larger potential for salt reduction strategies remains largely unexploited. More radical, mandatory targets for the food industry, complemented by comprehensive strategies for reducing other dietary salt sources are urgently needed to maximise the health and economic benefits to the population.
This is the first IMPACTNCD microsimulation model adapted to a Latin American country. This microsimulation methodology can be helpful for effective food policy-making and implementation in Brazil and other countries in the region.
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