Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England: A Modeling Study

Abstract

The United Kingdom was among the first countries to introduce a salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified salt intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level salt intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level salt intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710-84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390-112 260) premature strokes, generating 542 850 (95% CI, 529 020-556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570-£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050-88 470) premature IHD cases, 126 010 (95% CI, 118 600-126 460) premature strokes and achieve £1260 million (95% CI, £1180-£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the salt reduction program to achieve further reductions in population salt intake and CVD burden should be a high priority.