Introduction:
Cardiovascular disease (CVD) accounts for over 800,000 US deaths annually, with substantial disparities by race. Poor diet is a leading CVD risk factor, including low intake of fruit and vegetable (F&V). Few data exist regarding the potential population level impact and effect on race disparities of policies aimed at increasing F&V intake.
Aim:
To estimate CVD mortality reductions, including by race, potentially achievable by price reduction and mass media campaign interventions in the US population up to 2030.
Methods:
We developed a US IMPACT Food Policy Model to compare three contrasting policies targeting F&V intake: A - a national mass media campaign (MMC); B and C - a universal F&V price reduction of 10 and 30% respectively. The MMC assumed unequal coverage by age, gender and race, and duration of either 1 or 15 years.
Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections and NHANES. We used US population and CVD projections to 2030, F&V mortality effect sizes and best evidence effect sizes for each policy. We modelled cumulative deaths prevented or postponed and life years gained (LYG) by age, gender, race and CVD subtype from 2015 to 2030. Results were tested in a probabilistic sensitivity analysis using Monte Carlo simulation.
Results:
Scenario A (MMC) could result in 27,000 (95% CI: 21,000-33,000) to 85,000 (83,000-89,000) fewer deaths dependent upon media campaign duration (from 1 to 15 years), gaining up to 1,280,000 LYGs (1,250,000-1,320,000) by 2030. Approximately 62% of deaths prevented would be CHD; and 53% would be in men, with 20% being saved in year 1.
Scenario B (10% price decrease) could prevent approximately 90,000 deaths (71,000-114,000) and gain 1,450,000 LYGs (1,180,000-1,740,000) by 2030. Scenario C (30% price decrease) could prevent some 270,000 deaths (215,000-338,000) by 2030, representing a 3.9% reduction in expected CVD mortality.
Price reduction policies would have equitable effects in non-hispanic whites vs. blacks. In comparison, a MMC would be ~ 35% less effective in preventing CVD deaths in non-Hispanic blacks.
Conclusions:
Price reduction policies (10 or 30%) and a nationwide MMC would each effectively reduce US CVD mortality. A 30% price reduction policy would save most lives and do so most equitably. Deaths prevented via a MMC might reduce substantially after year 1 and also increase disparities. These results inform potential fiscal and population level strategies to reduce CVD mortality in the US.
An Optimal Inventory Policy for Subsequent Price Reduction Problem
