Background
Methods
Study design
Distributions of dietary targets
Etiologic effects of dietary changes
Dietary factora
| Educational levelb
| 2012 intake among US adultsc
| Percent (%) change in intake per 10% price changed
| Disease outcomese
| Unit of etiologic effect | Etiologic effect at age 50f
| Etiologic effect at age 70f
|
---|---|---|---|---|---|---|---|
mean ± SD | RR (95% CIs) | RR (95% CIs) | |||||
Fruit (g/d) (excl. 100% fruit juices) | < HS | 90.9 ± 88.3 | 15.5 | ↓ CHD | per 1 serving (100 g)/d | 0.93 (0.89–0.97) | 0.95 (0.92–0.98) |
HS | 103 ± 105 | 14.2 | ↓ Ischemic stroke | 0.86 (0.80–0.92) | 0.90 (0.86–0.94) | ||
COL | 146 ± 112 | 13.1 | ↓ Hemorrhagic stroke | 0.69 (0.56–0.84) | 0.77 (0.67–0.89) | ||
Vegetables (g/d) (incl. legumes) | < HS | 162 ± 79.6 | 15.5 | ↓ CHD | per 1 serving (100 g)/d | 0.94 (0.91–0.97) | 0.96 (0.94–0.98) |
HS | 168 ± 92.1 | 14.2 | ↓ Ischemic stroke | 0.80 (0.70–0.92) | 0.91 (0.84–0.97) | ||
COL | 217 ± 129 | 13.1 | ↓ Hemorrhagic stroke | 0.80 (0.67–0.96) | 0.86 (0.76–0.97) | ||
Nuts/seeds (g/d) | < HS | 5.78 ± 14.2 | 15.5 | ↓ CHD | per 1 serving (1 oz)/wk | 0.91 (0.87–0.94) | 0.93 (0.91–0.96) |
HS | 9.87 ± 13.1 | 14.2 | ↓ Diabetes | 0.96 (0.94–0.98) | 0.97 (0.96–0.99) | ||
COL | 17.7 ± 30.9 | 13.1 | |||||
Whole grains (g/d) | < HS | 15.5 ± 16.1 | 15.5 | ↓ CHD | per 1 serving (50 g)/d | 0.96 (0.93–0.99) | 0.97 (0.95–0.99) |
HS | 19.7 ± 17.9 | 14.2 | ↓ Ischemic stroke | 0.90 (0.83–0.97) | 0.93 (0.88–0.98) | ||
COL | 26.5 ± 19.7 | 13.1 | ↓ Hemorrhagic stroke | 0.90 (0.83–0.97) | 0.93 (0.88–0.98) | ||
↓ Diabetes | 0.86 (0.80–0.92) | 0.90 (0.86–0.94) | |||||
Processed meats (g/d) | < HS | 29.4 ± 14.1 | –3.4 | ↑ CHD | per 1 serving (50 g)/d | 1.24 (1.04–1.47) | 1.16 (1.03–1.30) |
HS | 33.6 ± 21.3 | –3.2 | ↑ Diabetes | 1.65 (1.30–2.08) | 1.41 (1.20–1.65) | ||
COL | 27.2 ± 16.5 | –2.9 | |||||
Red meats, unprocessed (g/d) | < HS | 52.8 ± 28.6 | –3.4 | ↑ Diabetes | per 1 serving (100 g)/d | 1.47 (1.14–1.88) | 1.30 (1.09–1.54) |
HS | 50.2 ± 19.7 | –3.2 | |||||
COL | 40.0 ± 24.6 | –2.9 | |||||
Sugar-sweetened beverages (8 oz/d) | < HS | 1.49 ± 1.56 | –7.3 | ↑ BMI (baseline BMI < 25) | ↑ BMI (baseline BMI < 25) | 0.10 kg/m2 (0.05–0.15) | 0.10 kg/m2 (0.05–0.15) |
HS | 1.31 ± 1.56 | –6.7 | ↑ BMI (baseline BMI ≥ 25) | 0.23 kg/m2 (0.14–0.32) | 0.23 kg/m2 (0.14–0.32) | ||
COL | 0.69 ± 0.99 | –5.6 | ↑ CHD, direct effect (BMI adjusted) | 1.26 (1.15–1.37) | 1.17 (1.10–1.24) | ||
↑ Diabetes, direct effect (BMI adjusted) | 1.27 (1.11–1.46) | 1.18 (1.07–1.29) |
Effect of price changes on dietary intakes
Mortality outcomes
Data analysis
Results
Dietary factors, price-responsiveness, and etiologic effects
Cardiometabolic deaths potentially prevented by price changes
Dietary factors | Disease outcomeb
| 10% price changec
| 30% price changec
| ||
---|---|---|---|---|---|
No. of deaths/year prevented (95% UI) | Proportion (%) of deaths prevented (95% UI) | No. of deaths/year prevented (95% UI) | Proportion (%) of deaths prevented (95% UI) | ||
Overall diet | CHD | 12,236 (11,320–13,230) | 3.4 (3.1–3.6) | 33,293 (30,887–35,798) | 9.2 (8.5–9.9) |
Hypertensive HD | 45 (34–60) | 0.1 (0.1–0.2) | 134 (102–179) | 0.4 (0.3–0.5) | |
Stroke | 6942 (6456–7430) | 5.5 (5.1–5.9) | 18726 (17,485–19,955) | 14.9 (13.9–15.8) | |
Diabetes | 2274 (2063–2626) | 3.4 (3.1–4.0) | 6287 (5756–7050) | 9.5 (8.7–10.6) | |
CMD, total | 23174 (22,024–24,595) | 3.4 (3.2–3.6) | 63268 (60,425–66,719) | 9.2 (8.8–9.7) | |
Fruit | CHD | 2213 (1852–2643) | 0.6 (0.5–0.7) | 6143 (5144–7316) | 1.7 (1.4–2.0) |
Stroke | 3038 (2726–3397) | 2.4 (2.2–2.7) | 8308 (7478–9256) | 6.6 (5.9–7.4) | |
CMD, total | 5265 (4771–5817) | 0.8 (0.7–0.8) | 14475 (13125–15,974) | 2.1 (1.9–2.3) | |
Vegetables | CHD | 2873 (2443–3359) | 0.8 (0.7–0.9) | 8223 (7011–9578) | 2.3 (1.9–2.6) |
Stroke | 3423 (3044–3818) | 2.7 (2.4–3.0) | 9554 (8497–10,585) | 7.6 (6.7–8.4) | |
CMD, total | 6294 (5722–6901) | 0.9 (0.8–1.0) | 17749 (16,176–19,458) | 2.6 (2.4–2.8) | |
Nuts/seeds | CHD | 3148 (2710–3599) | 0.9 (0.7–1.0) | 8214 (7116–9326) | 2.3 (2.0–2.6) |
Diabetes | 269 (227–316) | 0.4 (0.3–0.5) | 701 (592–822) | 1.1 (0.9–1.2) | |
CMD, total | 3413 (2976–3863) | 0.5 (0.4–0.6) | 8912 (7788–10,049) | 1.3 (1.1–1.5) | |
Whole grains | CHD | 587 (457–720) | 0.2 (0.1–0.2) | 1741 (1356–2137) | 0.5 (0.4–0.6) |
Stroke | 514 (453–579) | 0.4 (0.4–0.5) | 1522 (1343–1712) | 1.2 (1.1–1.4) | |
Diabetes | 425 (372–480) | 0.6 (0.6–0.7) | 1252 (1099–1413) | 1.9 (1.7–2.1) | |
CMD, total | 1527 (1376–1683) | 0.2 (0.2–0.2) | 4518 (4072–4977) | 0.7 (0.6–0.7) | |
Processed meats | CHD | 1700 (1315–2206) | 0.5 (0.4–0.6) | 5048 (3906–6493) | 1.4 (1.1–1.8) |
Diabetes | 477 (385–580) | 0.7 (0.6–0.9) | 1408 (1141–1703) | 2.1 (1.7–2.6) | |
CMD, total | 2175 (1777–2689) | 0.3 (0.3–0.4) | 6447 (5286–7944) | 0.9 (0.8–1.2) | |
Red meats, unprocessed | Diabetes | 140 (106–176) | 0.2 (0.2–0.3) | 419 (316–524) | 0.6 (0.5–0.8) |
Sugar sweetened beverages | CHD | 3544 (2921–4302) | 1.0 (0.8–1.2) | 10091 (8354–12,027) | 2.8 (2.3–3.3) |
Hypertensive HD | 45 (34–60) | 0.1 (0.1–0.2) | 134 (102–179) | 0.4 (0.3–0.5) | |
Stroke | 67 (60–76) | 0.1 (0.0–0.1) | 201 (178–226) | 0.2 (0.1–0.2) | |
Diabetes | 986 (804–1349) | 1.5 (1.2–2.0) | 2729 (2267–3424) | 4.1 (3.4–5.2) | |
CMD, total | 4647 (3993–5680) | 0.7 (0.6–0.8) | 13169 (11,428–15,366) | 1.9 (1.7–2.2) |
Disparities in cardiometabolic deaths potentially prevented by price changes
Disease outcomeb
| Price change scenario | < High school (n = 60,742,522) | High school (n = 119,506,708)d
| College (n = 28,482,268) | ||||
---|---|---|---|---|---|---|---|---|
% price change | SES gradientc
| No. of deaths/year prevented (95% UI) | Proportion (%) of deaths prevented (95% UI) | No. of deaths/year prevented (95% UI) | Proportion (%) of deaths prevented (95% UI) | No. of deaths/year prevented (95% UI) | Proportion (%) of deaths prevented (95% UI) | |
CHD | 10% | Low | 2657 (2325–3008) | 3.0 (2.6–3.4) | 8054 (7255–8908) | 3.7 (3.3–4.1) | 1486 (1323–1728) | 2.8 (2.5–3.2) |
High | 3120 (2732–3531) | 3.5 (3.1–3.9) | 8054 (7255–8908) | 3.7 (3.3–4.1) | 1268 (1127–1478) | 2.4 (2.1–2.8) | ||
30% | Low | 7380 (6492–8243) | 8.2 (7.3–9.2) | 21816 (19755–23985) | 9.9 (9.0–10.9) | 3996 (3563–4560) | 7.5 (6.7–8.5) | |
High | 8546 (7534–9532) | 9.5 (8.4–10.6) | 21816 (19755–23985) | 9.9 (9.0–10.9) | 3463 (3090–3960) | 6.5 (5.8–7.4) | ||
Hypertensive HD | 10% | Low | 12 (8–17) | 0.1 (0.1–0.2) | 29 (19–43) | 0.1 (0.1–0.2) | 3 (2–5) | 0.1 (0.0–0.1) |
High | 14 (10–21) | 0.2 (0.1–0.3) | 29 (19–43) | 0.1 (0.1–0.2) | 3 (2–4) | 0.1 (0.0–0.1) | ||
30% | Low | 35 (25–52) | 0.4 (0.3–0.7) | 87 (57–127) | 0.4 (0.3–0.6) | 10 (7–16) | 0.2 (0.1–0.3) | |
High | 42 (29–61) | 0.5 (0.4–0.8) | 87 (57–127) | 0.4 (0.3–0.6) | 9 (6–13) | 0.2 (0.1–0.3) | ||
Stroke, total | 10% | Low | 1588 (1415–1767) | 5.0 (4.5–5.6) | 4307 (3871–4768) | 5.8 (5.2–6.4) | 1041 (939–1148) | 5.4 (4.9–6.0) |
High | 1864 (1662–2073) | 5.9 (5.2–6.5) | 4307 (3871–4768) | 5.8 (5.2–6.4) | 888 (801–981) | 4.6 (4.2–5.1) | ||
30% | Low | 4347 (3890–4803) | 13.7 (12.3–15.1) | 11633 (10518–12778) | 15.5 (14–17.1) | 2740 (2488–3002) | 14.2 (12.9–15.6) | |
High | 5007 (4487–5524) | 15.8 (14.1–17.4) | 11633 (10518–12778) | 15.5 (14–17.1) | 2388 (2165–2620) | 12.4 (11.2–13.6) | ||
Diabetes | 10% | Low | 585 (498–697) | 3.2 (2.7–3.8) | 1488 (1297–1756) | 3.7 (3.2–4.4) | 197 (171–294) | 2.4 (2.1–3.6) |
High | 687 (586–815) | 3.8 (3.2–4.5) | 1488 (1297–1756) | 3.7 (3.2–4.4) | 167 (146–255) | 2.0 (1.8–3.1) | ||
30% | Low | 1631 (1410–1899) | 9.0 (7.8–10.5) | 4104 (3613–4700) | 10.2 (9–11.7) | 557 (489–705) | 6.7 (5.9–8.5) | |
High | 1895 (1643–2202) | 10.5 (9.1–12.2) | 4104 (3613–4700) | 10.2 (9–11.7) | 476 (418–618) | 5.8 (5.1–7.5) | ||
CMD, total | 10% | Low | 5286 (4847–5735) | 3.1 (2.9–3.4) | 14954 (13897–16010) | 3.6 (3.3–3.8) | 2934 (2714–3557) | 2.9 (2.7–3.5) |
High | 6210 (5697–6735) | 3.7 (3.4–4.0) | 14954 (13897–16010) | 3.6 (3.3–3.8) | 2501 (2310–3074) | 2.5 (2.3–3.0) | ||
30% | Low | 14672 (13487–15843) | 8.7 (8.0–9.3) | 40732 (38042–43415) | 9.8 (9.1–10.4) | 7906 (7357–8853) | 7.7 (7.2–8.7) | |
High | 16986 (15632–18331) | 10 (9.2–10.8) | 40732 (38042–43415) | 9.8 (9.1–10.4) | 6847 (6372–7751) | 6.7 (6.2–7.6) |