Luz Maria Sánchez-Romero 1 , 2 , Joanne Penko 3 , 4 , Pamela G. Coxson 3 , 4 , Alicia Fernández 3 , 4 , Antoinette Mason 3 , 4 , Andrew E. Moran 5 , Leticia Ávila-Burgos 6 , Michelle Odden 7 , Simón Barquera 1 , Kirsten Bibbins-Domingo 3 , 4 , 5 , 8 , *
1 November 2016
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.
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.
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.
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.
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.
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).
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.