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

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.墨西哥的糖尿病患病率位居全球前列。2014年，墨西哥对含糖饮料（sugar-sweetened beverages, SSBs）开征全国性消费税，旨在降低该国居高不下的含糖饮料消费量——而含糖饮料是可预防的糖尿病与心血管疾病（cardiovascular disease, CVD）致病因素。本研究依托已成熟的心血管疾病计算机模拟模型，结合墨西哥人口统计学、流行病学、含糖饮料消费量以及含糖饮料税实施后消费量短期变化的本国数据，对该国征收含糖饮料税可能带来的长期健康与经济影响进行预测。 方法与结果 本研究使用「墨西哥心血管疾病政策模型」——一款针对35~94岁墨西哥成年人的状态转换模型——预测10年内，含糖饮料摄入量减少对糖尿病发病率、心血管疾病事件、直接糖尿病医疗成本以及死亡率的潜在未来影响。模型输入参数包括：征税后含糖饮料消费量的短期变化（即价格弹性，price elasticity），以及来自政府、市场调研机构与公共卫生机构的数据。本研究设置了两类主要模拟场景：一是含糖饮料消费量降低10%（对应税改后实际观测到的降幅），二是消费量降低20%（若进一步提高征税水平或辅以其他控消费措施则可实现）。鉴于墨西哥民众是否会用其他来源的热量替代含糖饮料热量存在不确定性，本研究对热量补偿的多种取值进行了评估。 研究预测，若墨西哥成年人的含糖饮料消费量降低10%且热量补偿率为39%，那么2013至2022年间，将减少约189300例（95%不确定区间（uncertainty interval, UI）155400~218100）新发2型糖尿病病例、20400例新发脑卒中和心肌梗死病例，以及18900例死亡。该场景还预测，含糖饮料税可为墨西哥节省约9.83亿国际元（international dollars）（95% UI：7.69亿~11.73亿国际元）。糖尿病与心血管疾病事件降幅的相对值与绝对值在本次建模的最年轻年龄组（35~44岁）中最为显著。 本研究的优势包括：采用已成熟的心血管疾病数学模型，使用当代墨西哥生命统计数据、健康调研数据、医疗成本数据以及含糖饮料价格弹性估值，同时结合概率与确定性敏感性分析以考量不确定性。本研究的局限性包括：在缺乏墨西哥本土数据时，部分输入参数依赖美国相关研究（具体为风险因素与心血管疾病结局的关联数据[源自弗雷明汉心脏研究（Framingham Heart Study）]以及含糖饮料热量补偿假设）；除糖尿病相关医疗成本外，其他医疗成本的数据较为有限；且缺乏针对不同地理与经济亚群的长期含糖饮料价格弹性相关信息。 结论 墨西哥的高糖尿病患病率已然构成公共卫生危机。尽管目前尚不清楚该国含糖饮料税的长期影响，但基于实际观测到的消费量降幅所做出的上述预测表明，墨西哥的含糖饮料税或可大幅降低糖尿病与心血管疾病的发病率与死亡率，同时削减医疗开支。