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

Date Published: November 1, 2016

Publisher: Public Library of Science

Author(s): Luz Maria Sánchez-Romero, Joanne Penko, Pamela G. Coxson, Alicia Fernández, Antoinette Mason, Andrew E. Moran, Leticia Ávila-Burgos, Michelle Odden, Simón Barquera, Kirsten Bibbins-Domingo, Tony Blakely

Abstract: 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.

Partial Text: Sugar-sweetened beverage (SSB) consumption has risen rapidly in Mexico in recent years [1,2], with one-fifth of total daily caloric intake among adults currently estimated to come from SSBs (including sugar-sweetened soda, coffee, tea, and agua fresca [flavored water]). Observational and intervention studies have demonstrated that higher SSB consumption is linked to greater risk of cardiometabolic outcomes [3–5]. Of particular concern in Mexico is the link between high SSB consumption and obesity and diabetes given the dramatic increase in these conditions over a short period of time [6]. The prevalence of obesity and diabetes in Mexico now rank among the highest in the world; approximately 70% of Mexican adults are considered overweight or obese, and 14% have diabetes [7]. Diabetes is now the leading cause of death and, in 2011, cost the Mexican government an estimated US$7.7 billion in direct and indirect costs [8,9]. As a result of recent trends, Mexico is projected to bear an ever increasing burden of health-related costs from diabetic complications including cardiovascular disease (CVD).

Mexican men consumed an average of 1.24 (SE = 0.07) servings of SSBs per day in 2012, and women consumed an average of 0.86 (SE = 0.04) servings per day (Table 1). Men and women consumed a median 0.97 (interquartile range 0–1.68) and 0.64 (interquartile range 0–1.41) servings per day, respectively (S1 Table). Overall, younger adults had higher SSB consumption than older adults. Assuming no change in SSB consumption from that observed in 2012 and assuming current obesity rates, model simulations project 3.9 million new cases of diabetes and 1.2 million CVD deaths occurring among adults 35 to 94 y old between 2013 and 2022.

Mexico’s SSB consumption has increased in recent years such that SSB calories now account for a substantial proportion of overall caloric intake [2]. Our population modeling of CVD and diabetes in Mexico suggests that if Mexico’s SSB tax leads to population-wide reductions in SSB intake, as suggested by declines in SSB purchases already observed since the initiation of the tax [11], the policy will have a profound impact on disease burden in Mexico. We project that substantial health gains and cost savings are likely to result from reduced SSB consumption stemming from the current 10% excise tax, particularly among younger Mexicans, who are the highest consumers of these beverages.



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