Modelling the effect of compliance with WHO salt recommendations on cardiovascular disease mortality and costs in Brazil

PLoS One. 2020 Jul 9;15(7):e0235514. doi: 10.1371/journal.pone.0235514. eCollection 2020.

Abstract

Introduction: Cardiovascular diseases (CVDs) represent the main cause of death among non-communicable diseases (NCDs) in Brazil, and they have a high economic impact on health systems. Most populations around the world, including Brazilians, consume excessive sodium, which increases blood pressure and the risk of CVDs.

Objective: To model the estimated deaths and costs associated with CVDs, which are mediated by increased blood pressure attributable to excessive sodium consumption in adults from the perspective of the Brazilian public health system in 2017.

Methods: We employed two macrosimulation methods, using top-down approaches and based on the same relative risks. The models estimated the mortality and costs-of-illness attributable to excessive sodium intake and mediated by hypertension for adults aged over 30 years in 2017. Direct healthcare cost data (inpatient care, outpatient care and medications) were extracted from the Ministry of Health information systems and official records.

Results: In 2017, an estimated 46,651 deaths from CVDs could have been prevented if the average sodium consumption had been reduced to 2 g/day in Brazil. Premature deaths related to excessive sodium consumption caused 575,172 Years of Life Lost and US$ 752.7 million in productivity losses to the economy. In the same year, the National Health System's costs of hospitalizations, outpatient care and medication for hypertension attributable to excessive sodium consumption totaled US$192.1 million. The main causes of death and costs associated with CVDs were coronary heart disease and stroke, followed by hypertensive disease, heart failure and aortic aneurysm.

Conclusion: Excessive sodium consumption is estimated to account for 15% of deaths by CVDs and to 14% of the inpatient and outpatient costs associated with CVD. It also has high societal costs in terms of premature deaths. CVDs are a leading cause of disease and economic burden on the global, regional and country levels. As a largely preventable and treatable conditions, CVDs require the strengthening of cost-effective policies, supported by evidence, including modeling studies, to reduce the costs relating to illness borne by the Brazilian public health system and society.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brazil
  • Cost of Illness*
  • Female
  • Guideline Adherence
  • Heart Diseases / economics
  • Heart Diseases / epidemiology*
  • Heart Diseases / etiology
  • Heart Diseases / mortality
  • Humans
  • Male
  • Models, Theoretical*
  • Recommended Dietary Allowances*
  • Sodium Chloride, Dietary / adverse effects*
  • Sodium Chloride, Dietary / standards
  • World Health Organization

Substances

  • Sodium Chloride, Dietary

Grants and funding

This article was possible due to an unrestricted research grant from the IDRC (International Research Development Centre of Canada), project #108167, “Scaling Up and Evaluating Salt Reduction Policies and Programs in Latin American Countries". The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; and in the decision to publish the results.