Li Jesse Hao Jing Zhang Lijing L Yan Yangfeng Wu The George Institute for Global Health at Peking University Health Science Centre School of Public Health Peking University ID: 693838
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Slide1
Yuan Ma, Feng J He, Nicole Li, Jesse Hao, Jing Zhang, Lijing L. Yan, Yangfeng WuThe George Institute for Global Health at Peking University Health Science CentreSchool of Public Health, Peking University5th August 2015, Valencia, Spain
Salt sales survey: a
simplified method to evaluate population
salt reduction
program
sSlide2
www.actiononsalt.org.ukSlide3
Lim et al. Lancet 2012;380:2224
S
alt intake
Cardiovascular
disease (
62
% strokes ,49% CHD)
？
High blood
pressure
TOP
risk factor of global disease burden in 2010
BackgroundSlide4
Salt intake in China one of the highest in the world (≈12-14g/d)
≈
80%
added
by
consumersMore than 1 in 4 adults have hypertension 24h urine collection
√: accurate
×:
High participant burden; costly;
×:
Completeness?
Background Slide5
AimTo determine whether a salt sales survey could serve as a simplified method to evaluate community-based salt reduction programsSlide6
CRHI-SRS main study design120 villages in 10 counties from 5 provincesIntervention(60 villages)
Randomization
Randomization
HE
(
30
villages)
H
ealth
E
ducation
Delivery of salt
substituteHE+PS (30 villages)Health
E
ducation
Delivery of
s
alt substitute
P
rice
S
ubsidy
≈
2400 individuals collected one 24h urine collection at the end of the trial
Control
(
60
villages
)
No
interventionSlide7
Salt sales Survey
PS+HE
10
villages
Control
10 villages
HE10 villagesHE(30 villages)
Random sampling
PS+HE
(30 villages)
50
shops
56 shops60 shops 166 Shops invited
Control
(
60
villages)
40 shops
44 shops
45 shops
1
had no telephone
3 closed down 1 merged by another shop
5 could not be reached
1
refused to participate
1
did
not sell
salt
1
closed down
8 could
not be
reached
2
refused to participate
2
closed down
12
could not be
reached
129
shops recruited
An independent researcher called the shopkeepers
monthly
to collect
salt
sales dataSlide8
Regular salt vs Salt Substitute
0.25g
Nacl
(salt)
0.25g Kcl1 g
1 g↓Blood pressureSlide9
ResultsSalt substitute sales trend by group
The last PS
intervention
The last HE
interventionSlide10
Salt substitute sales vs 24h urinary KResultsSlide11
Salt substitute sales vs 24h urinary NaResultsSlide12
ResultsEffect size (Intervention vs control)Assessed by 24-hour UrineEstimated from SS salesdifference in sodium intake-7.0mmol/d
-
8.0
mmol
/d
difference in potassium intake14.1mmol
/d14.2mmol/d114%101%Slide13
ResultsCostSalt sales sur
v
ey:
¥RMB
57,000 (
≈ $10,000 )24h Urine collection :
RMB 420,000 (≈ $70,000 )Slide14
Summary- Salt sales surveySS sales: PS+HE>HE>control24h urinary K:PS+HE>HE>control24h urinary N
a
:PS+HE
<HE<control
Intervention effect estimated from SS sales
Potassium: 114% of that from 24h urine.
Sodium: 110% of that from 24h urineLarger statistical powerLower costSlide15
Limitations? Salt intake levelSuitable situation:Salt added by consumers is major source Population should be stable
Community-basedSlide16
ConclusionA salt sales survey could serve as a simple, sensitive and cost-effective method to evaluate community-based salt reduction
programs
where salt is mainly added by the consumers.Slide17
AcknowledgementSponsorsThe US NIH NHLBIThe US CDC DHDSPUnited Health Group
Partners
US CDC
The Duke University
The George Institute for Global Health, Australia
China Medical UniversityJiaotong
University Medical CollegeHebei Provincial CDCNingxia Medical UniversityChangzhi Medical UniversityParticipantsSlide18
Thank you!Any Questions?Slide19
TimelineMay 2011
Price subsidy
Health education
Delivery of Salt substitut
e
Sep 2012
Dec 2012
Intervention
Monthly salt sales survey
J
une
2013
24h urine collection
July 2011
S
urveySlide20