47
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Projected Impact of Mexico’s Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Rates 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 Findings

          We 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.

          Conclusions

          Mexico’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.

          Abstract

          Using consumption trends following the implementation of Mexico's tax on sugar sweetened beverages, Kirsten Bibbins-Domingo and colleagues estimate the tax's impact on diabetes cases, cardiovascular events, mortality and healthcare costs over the next ten years.

          Author Summary

          Why Was This Study Done?
          • The prevalence of obesity and diabetes in Mexico has risen dramatically in recent years, and the rate of diabetes in Mexico currently ranks among the highest in the world.

          • Mexicans consume a large volume of sugar-sweetened beverages (SSBs), a preventable risk factor for obesity, diabetes, and cardiovascular diseases.

          • In order to address the obesity and diabetes epidemic, the Mexican government implemented a 10% excise tax on SSBs in 2014.

          • Although consumer data suggest that the tax has resulted in a decrease in SSB purchases, little is known about the longer-term impact the SSB tax will have on disease burden and healthcare costs in Mexico.

          What Did the Researchers Do and Find?
          • We conducted a computer simulation study in order to understand the potential impact of the tax on diabetes, cardiovascular diseases, mortality, and healthcare costs associated with diabetes among Mexican adults 35–94 years of age over a period of 10 years (2013–2022).

          • To do this, we developed a Mexico version of an established model of cardiovascular disease in the US (the Cardiovascular Disease Policy Model) using national-level data from Mexico wherever possible.

          • We found that the 10% tax on SSBs will likely prevent approximately 189,300 new cases of type 2 diabetes, 20,400 incident strokes and heart attacks, and 18,900 deaths over 10 years among adults 35–94 years of age, and is expected to result in 983 million international dollars in savings in healthcare costs because of the prevention of diabetes cases.

          • The largest reductions in health burden and healthcare spending are projected to occur among the youngest adults included in the simulation (those 35–44 years of age).

          What Do These Findings Mean?
          • The national tax on SSBs in Mexico is projected to have a substantial impact on the burden of diabetes, cardiovascular diseases, and mortality over 10 years.

          • With the largest effects of the tax observed among the youngest age group modeled, we expect the impact of the intervention to become more dramatic as the population ages.

          • The SSB tax may be an important component in a multifaceted strategy by the Mexican government to curb the obesity and diabetes epidemic in Mexico.

          Related collections

          Most cited references 38

          • Record: found
          • Abstract: found
          • Article: not found

          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

            Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              The Framingham Offspring Study. Design and preliminary data.

                Bookmark

                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                1 November 2016
                November 2016
                : 13
                : 11
                Affiliations
                [1 ]Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
                [2 ]Department of Epidemiology and Public Health, University College London, London, United Kingdom
                [3 ]Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
                [4 ]UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
                [5 ]Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America
                [6 ]Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
                [7 ]Department of Epidemiology, Oregon State University, Corvalis, Oregon, United States of America
                [8 ]Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
                University of Otago, Wellington, NEW ZEALAND
                Author notes

                The authors have declared that no competing interests exist.

                • Conceptualization: LMSR AF AMo SB KBD.

                • Data curation: LMSR JP PC LA.

                • Formal analysis: LMSR JP AM MO KBD.

                • Funding acquisition: AF KBD SB.

                • Investigation: LMSR JP SB LA KBD.

                • Methodology: PC JP AM MO KBD.

                • Project administration: JP KBD.

                • Resources: KBD LMSR JP PC LA.

                • Software: PC.

                • Supervision: KBD SB.

                • Validation: LMSR PC JP KBD.

                • Visualization: KBD PC JP.

                • Writing – original draft: LMSR JP PC AM MO KBD.

                • Writing – review & editing: LMSR JP PC AF AM AMo LA MO SB KBD.

                Article
                PMEDICINE-D-16-01113
                10.1371/journal.pmed.1002158
                5089730
                27802278
                3431c11b-0985-4e86-a7ba-6949cf5e113f
                © 2016 Sánchez-Romero et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 3, Pages: 17
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: R03TW009061
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: R03TW009061
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100005909, University of California Institute for Mexico and the United States;
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100003141, Consejo Nacional de Ciencia y Tecnología;
                Award Recipient :
                Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health ( http://www.fic.nih.gov/Pages/Default.aspx) under Award Number R03TW009061 (AF, KBD, SB) and by a Grant for Collaborative Projects ( http://ucmexus.ucr.edu/funding/grant_collaborative.html) from the University of California Institute for Mexico and the United States (UC MEXUS) and the National Council of Science and Technology (CONACYT) Mexico (KBD, SB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                People and Places
                Population Groupings
                Ethnicities
                Mexican People
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Diseases
                People and places
                Geographical locations
                North America
                Mexico
                Biology and Life Sciences
                Nutrition
                Diet
                Beverages
                Medicine and Health Sciences
                Nutrition
                Diet
                Beverages
                People and Places
                Population Groupings
                Age Groups
                Adults
                Medicine and Health Sciences
                Public and Occupational Health
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Custom metadata
                Data for this study come from sources detailed in the paper. Data on CVD risk factors and sugar sweetened beverage consumption come from the ENSANUT study group ( http://ensanut.insp.mx/). Framingham Heart Study data are available following approval of research applications submitted through the National Heart, Lung, and Blood Institute's Biologic Specimen and Data Repository Information Coordinating Center (available at http://biolincc.nhlbi.nih.gov/studies/framcohort/?q=framingham for the Framingham Cohort and http://biolincc.nhlbi.nih.gov/studies/framoffspring/?q=framingham for the Offspring study). Health survey, vital statistics, and healthcare cost data are publicly available from government sources described in the paper. Investigators interested in working with the CVD Policy Model software can contact Dr. Bibbins-Domingo by email. Interested authors can submit a brief (1–2 page) research proposal and collaboration plan by email that will be considered by the CVD Policy Model team. The CVD Policy Model team will interact with interested researchers in order to assess the feasibility of collaboration and clarify any questions about the research question, particularly whether the CVD Policy Model is designed to address the question. The CVD Policy Model has established a Creative Commons agreement for the purpose of establishing rules for collaborations with outside researchers. The commons allows for outside researchers to use the software, ensures that the software is used appropriately, and asks collaborators to share modifications and improvements to the software with the CVD Policy Model team. A copy of the Creative Commons agreement is available online as a supplementary file ( S1 File). If interested researchers propose an analysis and sign our Creative Commons agreement, and the proposal is approved by the CVD Policy Model team, the software will be shared.

                Medicine

                Comments

                Comment on this article