Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model.
Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model.
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DOI：
10.1136/bmj.f6048
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发表时间：
2013-10-22
期刊：
影响因子：
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通讯作者：
Goldhaber-Fiebert JD
中科院分区：
文献类型：
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作者：
Basu S;Babiarz KS;Ebrahim S;Vellakkal S;Stuckler D;Goldhaber-Fiebert JD
目的研究征收棕榈油税对印度高脂血症和心血管疾病死亡率的潜在影响。设计经济-流行病学模型。建模方法构建了印度人群中心肌梗死和中风死亡率的微观模拟模型，结合了具有全国代表性的关于收缩压、总胆固醇、吸烟、糖尿病和心血管事件史的数据，并按年龄、性别和城乡居住地进行分层。家庭支出数据被用来估计棕榈油消费量在石油价格变化后的变化，以及征收税收后可能出现的替代油。在2014-23年间，对购买棕榈油征收20%的消费税。主要观察指标该模型被用来预测未来因心肌梗死和中风导致的死亡率，以及考虑到食品价格上涨的影响的税收对食品不安全的潜在影响。结果对购买棕榈油征收20%的税，如果人们不用其他棕榈油替代棕榈油消费，预计在2014年至23年期间，印度因心肌梗死和中风而死亡的人数将减少约363万 000(95%可信区间为247 000至479 000)(心血管死亡人数减少1.3%)。鉴于随着棕榈油价格上涨20%，估计棕榈油将被其他油类取代，多不饱和脂肪消费量增加的有利影响将使预计的死亡人数减少多达421 000(256 000至586 000)。考虑到不同的消费和心血管风险，预计这项税收将使男性比女性受益更多，城市人口比农村人口受益更多。在包含税收对总体食品支出的影响的情景中，税收可能会使粮食不安全增加1%，导致16 000(95%可信区间12 000到22 000)死亡。结论通过税收减少棕榈油摄入量可能会适度降低高脂血症和心血管死亡率，但潜在的分配后果对男性和城市人口有不同的好处，并影响食品安全。
Objective To examine the potential effect of a tax on palm oil on hyperlipidemia and on mortality due to cardiovascular disease in India. Design Economic-epidemiologic model. Modeling methods A microsimulation model of mortality due to myocardial infarction and stroke among Indian populations was constructed, incorporating nationally representative data on systolic blood pressure, total cholesterol, tobacco smoking, diabetes, and cardiovascular event history, and stratified by age, sex, and urban/rural residence. Household expenditure data were used to estimate the change in consumption of palm oil following changes in oil price and the potential substitution of alternative oils that might occur after imposition of a tax. A 20% excise tax on palm oil purchases was simulated over the period 2014-23. Main outcome measures The model was used to project future mortality due to myocardial infarction and stroke, as well as the potential effect of a tax on food insecurity, accounting for the effect of increased food prices. Results A 20% tax on palm oil purchases would be expected to avert approximately 363 000 (95% confidence interval 247 000 to 479 000) deaths from myocardial infarctions and strokes over the period 2014-23 in India (1.3% reduction in cardiovascular deaths) if people do not substitute other oils for reduced palm oil consumption. Given estimates of substitution of palm oil with other oils following a 20% price increase for palm oil, the beneficial effects of increased polyunsaturated fat consumption would be expected to enhance the projected reduction in deaths to as much as 421 000 (256 000 to 586 000). The tax would be expected to benefit men more than women and urban populations more than rural populations, given differential consumption and cardiovascular risk. In a scenario incorporating the effect of taxation on overall food expenditures, the tax may increase food insecurity by <1%, resulting in 16 000 (95% confidence interval 12 000 to 22 000) deaths. Conclusions Curtailing palm oil intake through taxation may modestly reduce hyperlipidemia and cardiovascular mortality, but with potential distributional consequences differentially benefiting male and urban populations, as well as affecting food security.