A quasi-experimental study of New York City's sodium warning regulation and hypertension prevalence, 2005–2020

Objective: To quantify temporal trends in age-adjusted hypertension prevalence in New York City before and after implementation of a menu labeling regulation requiring sodium warning icons at chain restaurants. Methods: Using data from the New York City Community Health Survey, segmented regression models assessed: (1) the average annual percent change (AAPC) of age-adjusted hypertension prevalence during the pre-regulation period (2005-2015), (2) the annual percent change (APC) from 2015 to 2016 (regulation onset association), (3) the AAPC of age-adjusted hypertension prevalence during the regulation period (2016-2020), and (4) the percentage-point difference between the AAPCs of the pre-regulation and regulation periods. Results: We found a statistically significant average annual percent increase in the age-adjusted hypertension prevalence among the Hispanic population during the pre-regulation period (2005-2015 AAPC: 1.3 %, 95 % CI: 0.3 % to 2.3 %). The regulation's onset was significantly associated with a 4.2 % (95 % CI: 0.4 % to 8.0 %) increase in the age-adjusted hypertension prevalence among females from 2015 to 2016. During the regulation era, we observed statistically significant average annual percent decreases in age-adjusted hypertension prevalence among Black (2016-2020 AAPC: -1.9 %; 95 % CI: -2.5 % to -1.3 %) and female (2016-2020 AAPC: -3.5 %; 95 % CI: -5.0 % to -2.1 %) subgroups. Conclusions: Findings suggest a potential positive impact of the sodium warning regulation on hypertension prevalence. The decreasing trends in hypertension prevalence among female and Black populations suggest that sodium reduction policies may have differential impacts across subgroups. These empirical insights underscore the importance of sustained sodium reduction policies.