限盐能减轻心血管疾病负担并减少医疗费用支出

墨尔本——2014年度世界心脏病学大会（WCC）上报告的一项南非限盐政策模型研究表明，将盐摄入量控制在每日5g以内能使心血管疾病导致的死亡减少11%，并且还能显著减少自付医疗费用，尤其是对于经济状况不稳定的中等收入家庭。

这项研究基于南非成年人队列，采用现有最佳的调查数据和流行病学数据，包括血压水平、社会经济指标、医疗费用支出，尤其是涉及心血管疾病的自付医疗费用，以及当前盐摄入量，评估了南非政府2013年出台的限盐政策所带来的潜在健康和经济影响。2013年南非政府推行了常见加工食品中最高盐含量的强制政策，并且还开展了公众教育活动以期在2020年之前把居民每日盐摄入量控制在5g以内。

美国华盛顿大学/南非开普敦大学的David Watkins博士表示：“开展这项研究的目的是为了评估限盐政策对于卫生和经济结局的影响，因为现有的很多文献都主要关注降低死亡率，而我们希望了解更广泛的卫生效应。”

将盐摄入量控制在每日5g以内能使

心血管疾病导致的死亡减少11%

 

研究结果显示，一旦达到这一目标，心血管疾病将减少11%，这包括每年死亡病例大约减少5,600例，心血管疾病新发病例大约减少23,000例。

Watkins博士称：“由于存在心血管疾病是富贵病的说法，所以我们对不同的社会经济群体进行了分析，结果发现这种健康影响在各个社会经济群体中呈平均分布。”

这项模型研究还显示，减少盐摄入量能使政府卫生经费每年减少5,100万美元，个人自付医疗费用减少400万美元，尤其是对于收入位于中间三个层次（共分成五个层次）的家庭。

Watkins博士说：“这项政策的经济危机预防作用对于中产阶级最明显，因为这类家庭的公共医疗服务支出更大，或者会寻求更昂贵的私人医疗服务。”

Watkins博士指出，心血管疾病死亡率下降11%这一结果与其他国家的研究结果相当吻合，这是向实现世界心脏联盟2025年之前将心血管死亡率下降25%的目标迈进了一大步。

David Watkins博士

“我们对于医疗费用支出、盐摄入量、血压下降程度以及死亡率下降程度的估计已经是非常保守了，尽管如此，这项政策的卫生和经济效应仍然非常明显。”

Watkins博士还指出，研究结果显示减少的心血管死亡病例很多都涉及非缺血性高血压性心脏病，这类疾病在南非乃至其他撒哈拉以南非洲地区的心血管死亡病例中占有相当大的比例。

本次大会由世界心脏联盟资助。该研究的作者来自疾病控制优先项目网络，该机构由比尔和梅琳达•盖茨基金会资助。作者声明无其他利益冲突。

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By: BIANCA NOGRADY, Cardiology News Digital Network

AT WCC 2014

VITALS

Major finding: South African salt targets of less than 5 g/day could reduce cardiovascular mortality by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households.

Data source: Modeling study using survey and epidemiological data.

Disclosures: The study was conducted by authors from the Disease Control Priorities Network, funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.

MELBOURNE – Reducing salt intake to less than 5 g/day could reduce deaths from cardiovascular disease by 11% and significantly decrease out-of-pocket health expenditures, particularly among economically vulnerable middle-income households, according to a modeling study of South Africa’s salt reduction policy.

The study used surveys and epidemiological data to calculate the potential health and economic impacts of salt targets set by the South African government in 2013, which employs mandatory maximum levels in common processed foods, and public education campaigns to reduce daily salt intake below 5 g by 2020.

According to data presented at the World Congress of Cardiology 2014, achieving this goal would result in an 11% reduction in cardiovascular disease, including approximately 5,600 fewer deaths and 23,000 fewer new cases of cardiovascular disease each year.

"In terms of equity, we found that the health impact was fairly evenly distributed across different socioeconomic groups, which speaks a lot to the myth that cardiovascular diseases are diseases of affluence," said Dr. David Watkins, a hospitalist and physician-researcher at the University of Washington and University of Cape Town.

The modeling, based on a cohort of South African adults, also found the reduction in salt consumption was associated with a $51 million/year reduction in government health subsidies, and a $4 million reduction in individual out-of-pocket expenses, particularly in the middle three income quintiles.

"The financial risk protection from this policy mostly benefitted the middle class because these households pay more for public sector care or seek more costly private care," said Dr. Watkins.

Researchers used the best available data on blood pressure levels, socioeconomic indicators, and health expenditures – in particular out-of-pocket health costs for cardiovascular disease care – and current salt consumption.

"The purpose of this study was to look at the impact of the policy on health and economic outcomes, because a lot of the existing salt literature is focused primarily on reducing deaths – we wanted to look at the broader health system effects," Dr. Watkins said.

 

Dr. Watkins said the finding of an 11% reduction in cardiovascular disease mortality was fairly consistent with what had been found in other countries, and represented a significant step toward achieving the World Heart Federation goal of a 25% reduction in cardiovascular mortality by 2025.

"We used very conservative estimates of health expenditures, salt intake, blood pressure reduction, and mortality reduction. Despite that, the health and economic effects were quite substantial."

The modeling also showed that much of the reduction in cardiovascular mortality would be in nonischemic hypertensive heart disease, which Dr. Watkins said was driving a significant amount of cardiovascular mortality in South Africa, as well as the rest of sub-Saharan Africa.

The congress was sponsored by the World Heart Federation.

The study was conducted by authors from the Disease Control Priorities Network, which is funded by the Bill and Melinda Gates Foundation. There were no relevant conflicts of interest declared.