This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Population-level interventions that target risk factors for dementia (such as high blood pressure, smoking and obesity) save money and give people extra years in good health, a modelling study found. They include, for example, legislation to reduce salt and sugar in food, or introduce low emission zones.
These interventions reduce individual responsibility for lifestyle changes and benefit all sectors of society.
Given the likely increase in the number of people with dementia as our population ages, the benefits of these population-level policies could outweigh their costs.
The researchers hope their findings will encourage policymakers to implement population-level interventions.
More information about dementia can be found on the NHS website.
The issue: Can population-level policies on dementia risk factors save money?
More than 944,000 people in the UK are living with dementia; the NHS estimates that by 2030 this will rise to more than 1 million. The total cost of dementia in the UK is £42 billion; most (63%) is shouldered by people with dementia and their families.
A recent Lancet report states that high blood pressure, smoking and other risk factors account for up to 45% of dementia diagnoses worldwide. Action to reduce these risks might therefore delay or prevent dementia in many people.
Individual-level interventions (dietary advice and help to stop smoking, for instance) are effective, but they tend to bring most benefit to people at lowest risk (such as those with better education or more resources). Population-level approaches (reducing the salt in the food we buy, for instance, or increasing the price of cigarettes) might be more effective than individual interventions across the whole population.
In this study, researchers modelled the likely costs and impact of population-level approaches to reduce risk factors for dementia.
What’s new?
The researchers analysed the impact of population-level policies (on salt, sugar, tobacco, and so on) that had not been introduced in England (or were in place but could be extended). The policies aim to reduce risk factors for dementia such as high blood pressure, heavy drinking, air pollution and obesity.
Previous research had explored the impact of these risk factors on dementia. Researchers also had data on the effectiveness of each intervention at reducing a risk factor. They brought the evidence together to estimate how many extra years in good health (quality-adjusted life-years or QALYs) people would have if a population-level approach was introduced. They calculated the combined cost savings of reducing dementia risk factors over the course of an individual’s life (for the NHS, social care and informal care, in 2021 prices) and then extrapolated to the overall benefit over future generations.
They estimate that:
- reduced salt in food could give 39,433 quality-adjusted life-years (equivalent to 39,433 people each having an additional year of good health) and save £2.4 billion
- reduced sugar in food could give 17,985 quality-adjusted life-years and save £1 billion
- low emission zones in English cities with populations of 100,000 or more could give 5119 quality-adjusted life-years and save £260 million
- minimum alcohol unit pricing could give 4767 extra years in good health and save £280 million
- a 10% increase in cigarette prices could give 2277 quality-adjusted life-years and save £157 million
- compulsory bike helmets for children aged 5 to 18 years could give 1554 quality-adjusted life-years and save £91 million.
Why is this important?
All population-level approaches in this analysis improved health and led to savings for the NHS, social care and informal care. Legislation to reduce salt and sugar in processed food led to the biggest increase in years of good health, and the greatest savings.
Some risk factors for dementia (high blood pressure, obesity and diabetes) are expected to increase in the next few decades as the population ages. Population-level approaches address the risk factors, without placing the responsibility for behaviour change solely on individuals. The potential benefits could outweigh the initial costs of implementing such policies.
Dementia prevention is not usually part of the evaluation of population-level interventions. This study shows that including dementia prevention would probably increase the estimated benefits of interventions. The findings are in line with a New Zealand study that found that food taxes led to health gains and cost-savings.
The study relied on observational data from previous research to estimate the impact of the policy approaches to reduce dementia. The evidence used was good quality, but observational studies do not directly prove that the interventions themselves cause the reduction in dementia.
What’s next?
Further research could confirm how much each factor increases dementia risk in the UK, since the estimates used in this study were drawn from international research.
You may be interested to read
This is a summary of: Mukadam N, and others. Benefits of population-level interventions for dementia risk factors: an economic modelling study for England. The Lancet Health Longevity 2024; 5: 100611.
A press release from NIHR about the study. Public health measures to reduce dementia risk could save up to £4 billion. August 2024.
An article about the impact of hearing loss on dementia risk. Munro KJ, Dawes P. Commentary: dementia, hearing loss, and the danger of professional rabbit holes. ENT & Audiology News. September 2024.
Funding: This study was funded by the NIHR Three Schools’ Dementia Research Programme.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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