Background
Methods
The IMPACTNCD-BR model
Parameter | Outcome | Details | Comments | Source |
---|---|---|---|---|
Population size estimates | Population | Brazilian Institute of Geography and Statistics (IBGE) | Stratified by age and sex | Brazilian Institute of Geography and Statistics (IBGE) [17] |
Population projections | Population | 2010–2060 Brazil population projections produced by IBGE | Stratified by year, age and sex | Brazilian Institute of Geography and Statistics (IBGE) [18] |
Mortality | Deaths from CHD, stroke, and any other non-modelled causes | Underlying cause of death 2000–2016 | Stratified by year, age and sex | National Mortality Information System (SIM/SUS) [19] |
Sodium exposure | Exposure of individuals | National Household Budgetary Survey | Anonymised, individual-level dataset | |
Systolic blood pressure exposure | Exposure of individuals | National Health Survey | Anonymised, individual-level dataset | IBGE - National Health Survey (PNS) 2013 [22] |
Effect of sodium consumption on systolic blood pressure | Systolic blood pressure | Meta-analysis/meta-regression of 103 trials | Only trials with duration >7 days were analysed | Mozaffarian et al. [3] |
Reference level of sodium consumption | Ideal sodium consumption below which no excess risk was considered to occur | Evidence from ecological studies, randomised trials, and meta-analyses of prospective cohort studies | Intake levels associated with the lowest risk ranged from 614 to 2391 mg/day; in large, well-controlled randomised feeding trials, the lowest tested intake for which blood pressure reductions were clearly documented was 1500 mg/day | Mozaffarian et al. [3] |
Relative risk for systolic blood pressure | CHD and stroke incidence (ICD-10: I20–I25 and I60–I69) | Pooled analysis of 2 individual-level meta-analyses | Stratified by age and sex; adjusted for regression dilution and total blood cholesterol and, where available, lipid fractions (HDL and non-HDL cholesterol), diabetes, weight, alcohol consumption, and smoking at baseline | Micha et al. [23] |
Mortality from any cause excluding CHD and stroke | Individual-level meta-analysis of 48 prospective cohort studies | Adjusted for age, sex, race or ethnicity, deprivation, smoking, diabetes, inactivity, alcohol, and obesity | Stringhini et al. [24] | |
Reference level of systolic blood pressure | Ideal systolic blood pressure below which no excess risk was considered to occur | Evidence from randomised trials of antihypertensive drugs and the INTERSALT study | There may be health benefits by lowering systolic blood pressure down to 110 mm Hg | Singh et al. [25] |
Disease costs | Public hospitalisation costs for CHD and stroke | Underlying cause of hospitalisation (2018) | Average cost of hospitalisations per individual | National Hospital Information System (SIH/SUS) [26] |
Primary health, outpatient and informal care and medication costs for CHD and stroke | Costs were extrapolated to Brazilian settings | Leal et al. [27] |
Microsimulation model structure
Summary of evidence regarding the risks of excess sodium consumption
Policy effects
Modelling of food composition and sodium intake changes
Model outputs
Medical costs analyses
Sensitivity analyses and uncertainty analyses
Results
Health-related outcomes
Outcome | Men | Women | Persons | As percentage of total cases/deaths |
---|---|---|---|---|
CHD cases prevented or postponed | 67,000 (17,000 to 160,000) | 31,000 (6000 to 78,000) | 98,000 (23,000 to 240,000) | 0.072% (0.030 to 0.15%) |
Stroke cases prevented or postponed | 45,000 (11,000 to 100,000) | 39,000 (10,0 00 to 89,000) | 84,000 (22,000 to 190,000) | 0.14% (0.068 to 0.23%) |
CHD deaths prevented or postponed | 700 (−200 to 900) | 500 (−200 to 2000) | 1200 (−500 to 5000) | 0.064% (0.000 to 0.15%) |
Stroke deaths prevented or postponed | 700 (−200 to 3000) | 700 (−200 to 2800) | 1400 (−500 to 6000) | 0.12% (0.039 to 0.23%) |
Non-CVD deaths prevented or postponed | 6900 (2300 to 13,000) | 4600 (1400 to 9200) | 12,000 (3700 to 22,000) | 0.069% (0.041 to 0.11%) |
All deaths prevented or postponed | 8300 (1800 to 19,000) | 5800 (900 to 14,000) | 14,000 (2700 to 33,000) | 0.073% (0.045 to 0.11%) |
Costs of CHD and stroke
Outcome | Men | Women | Persons | As percentage of total costs |
---|---|---|---|---|
Change in total health-related costs | 190 (48 to 440) | 100 (23 to 250) | 290 (71 to 690) | 0.094% (0.055 to 0.17%) |
Total medical costs to SUS | 140 (36 to 330) | 78 (17 to 190) | 220 (54 to 530) | As above |
Total informal care costs | 46 (12 to 110) | 25 (6 to 61) | 71 (17 to 170) | As above |
Total CHD-related costs | 150 (38 to 350) | 70 (14 to 180) | 220 (52 to 530) | 0.072% (0.030 to 0.15%) |
CHD medical costs to SUS | 120 (29 to 270) | 54 (11 to 130) | 170 (40 to 400) | As above |
Informal care CHD costs | 36 (9 to 84) | 17 (3 to 42) | 52 (12 to 130) | As above |
Total stroke-related costs | 38 (10 to 86) | 33 (9 to 76) | 72 (19 to 160) | 0.14% (0.068 to 0.23%) |
Stroke medical costs to SUS | 28 (7 to 64) | 25 (7 to 56) | 53 (14 to 120) | As above |
Informal care stroke costs | 10 (3 to 22) | 9 (2 to 20) | 19 (5 to 42) | As above |