Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study
Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study
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DOI：
10.1371/journal.pmed.1002158
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发表时间：
2016-11-01
期刊：
影响因子：
15.8
通讯作者：
Bibbins-Domingo, Kirsten
中科院分区：
文献类型：
--
作者：
Maria Sanchez-Romero, Luz;Penko, Joanne;Bibbins-Domingo, Kirsten
背景墨西哥的糖尿病发病率是世界上最高的。2014年，墨西哥在全国范围内对含糖饮料（SSB）征税，以减少SSB的高消费水平，这是糖尿病和心血管疾病（CVD）的可预防原因。我们使用了一个已建立的计算机模拟模型的心血管疾病和国家的具体数据的人口统计学，流行病学，SSB消费，并在消费的SSB税后的短期变化，以项目潜在的长期健康和经济影响的SSB税收在墨西哥。方法和FindingsWe使用了心血管疾病政策模型，墨西哥，一个国家的过渡模型，墨西哥成年人年龄在35-94岁，预测未来减少SSB摄入对糖尿病发病率、CVD事件、直接糖尿病医疗保健成本和10年以上死亡率的潜在影响。模型输入包括SSB消费对税收的短期变化（价格弹性）以及来自政府和市场研究调查以及公共医疗机构的数据。模拟了两种主要情景：SSB消费减少10%（对应于税收实施后观察到的减少）和SSB消费减少20%（可能会增加税收水平和/或采取额外措施抑制消费）。考虑到墨西哥人将在多大程度上用其他来源的卡路里取代SSB中的卡路里的不确定性，我们评估了一系列卡路里补偿值。我们预测，墨西哥成年人减少10%的SSB消费，39%的卡路里补偿将导致约189，300（95%不确定区间[UI] 155，400 - 218，100）减少2型糖尿病病例，减少20，400例中风和心肌梗死事件，减少18，900例死亡。这一情景预测，SSB税可以为墨西哥节省9.83亿美元（95% UI 7.69亿美元-11.73亿美元）。最大的相对和绝对减少糖尿病和心血管疾病事件发生在最年轻的年龄组建模（35-44岁）。这项研究的优势包括使用一个建立的数学模型，心血管疾病和使用当代墨西哥人口动态统计，数据从健康调查，医疗保健成本，和SSB价格弹性估计，以及概率和确定性的敏感性分析，以解释不确定性。该研究的局限性包括依赖于美国的研究，而墨西哥缺乏特定的数据（特别是风险因素与心血管疾病结局之间的关联[来自心脏病研究]和SSB热量补偿假设），除糖尿病相关数据外的医疗保健费用数据有限，和缺乏长期SSB价格弹性，是特定的地理和经济subgroup.ConclusionsMexico的高糖尿病患病率的信息代表了公共卫生危机。虽然墨西哥SSB税的长期影响尚不清楚，但基于观察到的消费减少，这些预测表明墨西哥的SSB税可能会大幅降低糖尿病和心血管疾病的发病率和死亡率，同时降低医疗保健成本。
BackgroundRates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico.Methods and FindingsWe used the Cardiovascular Disease Policy Model-Mexico, a state transition model of Mexican adults aged 35-94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation.We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400-218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $ 769 million-$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35-44 y).This study's strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups.ConclusionsMexico's high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico's SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico's SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.