Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study.
Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study.
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DOI：
10.1016/s2468-2667(16)30037-8
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Scarborough P
中科院分区：
文献类型：
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作者：
Briggs ADM;Mytton OT;Kehlbacher A;Tiffin R;Elhussein A;Rayner M;Jebb SA;Blakely T;Scarborough P
2016年3月，英国政府提议对含糖饮料征收分级税(SSB；每100毫升含糖8克的饮料征收高额税，5-8克征收中等税，5克免税)。我们估计了行业对肥胖、糖尿病和龋齿征税的可能反应的影响。我们模拟了三种可能的行业反应：调整配方以降低糖浓度，提高产品价格，以及改变高糖、中糖和低糖饮料的市场份额。对于每个反应，我们定义了一个更好的情况和更差的情况健康情景。我们开发了一个比较风险评估模型，以评估每种情景对英国肥胖患病率、龋齿和2型糖尿病发病率的健康影响。该模型结合了SSB的销售和消费、疾病发生率和流行率、价格弹性估计以及SSB消费和疾病结果之间的关联估计的数据。我们从实验研究的荟萃分析(SSB和体重变化)、前瞻性队列研究的荟萃分析(2型糖尿病)和前瞻性队列研究(龋齿)中提取疾病关联参数。对健康最好的建模情景是SSB重新制定，从而使英国15名 470名肥胖成人和儿童的 383(95%不确定区间5102-306 743；0.9%)减少，19名 094(6920-32 678；每10万 000人年发病率减少31.1)，以及269名 375(82 211-470 928；每1000人年发病率减少4·4)每年减少龋齿、缺失或充填牙齿。在更好的情况下，SSB价格的上涨将导致肥胖成人和儿童减少81 594(3588-182 669；0.5%)，每年减少10 861(3899-18 964；17.7)糖尿病事件，以及149 378(45 231-262 013；2.4)每年减少龋齿、缺失或填充的牙齿。在更好的情况下，改变市场份额以增加低糖饮料的销售比例，将导致成人和儿童糖尿病患者减少91 042(4289-204 903；0.6%)，每年减少1,528(44，14-21 785；19·7)糖尿病病例，以及172 718(47 919-294 499；2·8)每年减少龋齿、缺失或充填牙齿。对肥胖和口腔健康最大的好处将是18岁以下的人，65岁以上的人糖尿病发病率的绝对降幅最大。软饮料税对健康的影响取决于行业对其实施情况。工业将如何反应以及对健康结果的估计存在不确定性。通过大幅调整产品配方可以最大限度地提高健康收益，如果通过提高高糖和中糖饮料的价格以及开展活动增加低糖产品的市场份额，将征税转嫁给购买者，可能会产生额外的好处。没有。
In March, 2016, the UK Government proposed a tiered levy on sugar-sweetened beverages (SSBs; high tax for drinks with >8 g of sugar per 100 mL, moderate tax for 5–8 g, and no tax for <5 g). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries. We modelled three possible industry responses: reformulation to reduce sugar concentration, an increase of product price, and a change of the market share of high-sugar, mid-sugar, and low-sugar drinks. For each response, we defined a better-case and worse-case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario on prevalence of obesity and incidence of dental caries and type 2 diabetes. The model combined data for sales and consumption of SSBs, disease incidence and prevalence, price elasticity estimates, and estimates of the association between SSB consumption and disease outcomes. We drew the disease association parameters from a meta-analysis of experimental studies (SSBs and weight change), a meta-analysis of prospective cohort studies (type 2 diabetes), and a prospective cohort study (dental caries). The best modelled scenario for health is SSB reformulation, resulting in a reduction of 144 383 (95% uncertainty interval 5102–306 743; 0·9%) of 15 470 813 adults and children with obesity in the UK, 19 094 (6920–32 678; incidence reduction of 31·1 per 100 000 person-years) fewer incident cases of type 2 diabetes per year, and 269 375 (82 211–470 928; incidence reduction of 4·4 per 1000 person-years) fewer decayed, missing, or filled teeth annually. An increase in the price of SSBs in the better-case scenario would result in 81 594 (3588–182 669; 0·5%) fewer adults and children with obesity, 10 861 (3899–18 964; 17·7) fewer incident cases of diabetes per year, and 149 378 (45 231–262 013; 2·4) fewer decayed, missing, or filled teeth annually. Changes to market share to increase the proportion of low-sugar drinks sold in the better-case scenario would result in 91 042 (4289–204 903; 0·6%) fewer adults and children with diabetes, 1528 (4414–21 785; 19·7) fewer incident cases of diabetes per year, and 172 718 (47 919–294 499; 2·8) fewer decayed, missing, or filled teeth annually. The greatest benefit for obesity and oral health would be among individuals aged younger than 18 years, with people aged older than 65 years having the largest absolute decreases in diabetes incidence. The health impact of the soft drinks levy is dependent on its implementation by industry. Uncertainty exists as to how industry will react and about estimation of health outcomes. Health gains could be maximised by substantial product reformulation, with additional benefits possible if the levy is passed on to purchasers through raising of the price of high-sugar and mid-sugar drinks and activities to increase the market share of low-sugar products. None.