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Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation
  1. Parke Edward Wilde1,
  2. Zach Conrad1,
  3. Colin D Rehm2,
  4. Jennifer L Pomeranz3,
  5. Jose L Penalvo1,
  6. Frederick Cudhea1,
  7. Jonathan Pearson-Stuttard4,5,
  8. Martin O’Flaherty5,
  9. Renata Micha1,
  10. Dariush Mozaffarian1
  1. 1Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
  2. 2Office of Community and Population Health, Montefiore Medical Center, Bronx, New York, USA
  3. 3College of Global Public Health, New York University, New York City, New York, USA
  4. 4School of Public Health, Imperial College London, London, UK
  5. 5Department of Public Health and Policy, Liverpool University, Liverpool, UK
  1. Correspondence to Dr Parke Edward Wilde, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; parke.wilde{at}


Background Suboptimal diets are a major contributor to cardiometabolic disease (CMD) mortality, and substantial disparities exist for both dietary quality and mortality risk across income groups in the USA. Research is needed to quantify how food pricing policies to subsidise healthy foods and tax unhealthy foods could affect the US CMD mortality, overall and by Supplemental Nutrition Assistance Program (SNAP) eligibility and participation.

Methods Comparative risk analysis based on national data on diet (National Health and Nutrition Examination Survey, 2003–2012) and mortality (mortality-linked National Health Interview Survey) and meta-analyses of policy-diet and diet-disease relationships.

Results A national 10% price reduction on fruits, vegetables, nuts and whole grains was estimated to prevent 19 600 CMD deaths/year, including 2.6% (95% UI 2.4% to 2.8%) of all CMD deaths among SNAP participants, 2.7% (95% UI 2.4% to 3.0%) among SNAP-eligible non-participants and 2.6% (95% UI 2.4% to 2.8%) among SNAP-ineligible non-participants. Adding a national 10% tax on sugar-sweetened beverages (SSBs) and processed meats would prevent a total of 33 700 CMD deaths/year, including 5.9% (95% UI 5.4% to 7.4%) of all CMD deaths among SNAP participants, 4.8% (95% UI 4.4% to 5.2%) among SNAP-eligible non-participants and 4.1% (95% UI 3.8% to 4.5%) among SNAP-ineligible non-participants. Adding a SNAP-targeted 30% subsidy for the same healthy foods would offer the largest reductions in both CMD mortality and disparities.

Conclusion National subsidies for healthy foods and taxes on SSBs and processed meats would each reduce CMD mortality; taxes would also reduce CMD mortality more steeply for SNAP participants than for non-participants.

  • cardiovascular disease
  • cost effective
  • modelling
  • nutrition
  • poverty

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  • Contributors DM, MO’F, JP-S and ZC conceived of this research project. ZC, FC, CDR and PEW conducted the quantitative analysis. CDR, ZC, JLPe and FC prepared the data for analysis. PEW, ZC, CDR, JLPe, JLPo, FC, JP-S, MO’F, RM and DM interpreted the results and wrote the manuscript.

  • Funding This research was supported by the NIH, NHLBI (R01 HL130735, PI Micha; R01 HL115189, PI Mozaffarian).

  • Competing interests DM reports personal fees from Haas Avocado Board, Pollock Communications, Life Sciences Research Organization, Boston Heart Diagnostics, GOED, DSM, Unilever North American and UpToDate. RM reports research funding from Unilever and personal fees from the World Bank and Bunge, all outside the submitted work. JLPe now is employed by Merck KGaA. For all other authors: none declared.

  • Patient consent Not required.

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