Mexican Sugar Tax Could Reap Huge Health and Cost Benefits

Liam Davenport

November 04, 2016

A national tax to reduce consumption of sugary drinks in Mexico could have a substantial impact on rates of diabetes and deaths from cardiovascular disease (CVD) and yield significant healthcare cost savings over 10 years, US researchers have predicted.

The 10% tax on sugar-sweetened beverages (SSBs), at 1 Mex$/L, was introduced by the Mexican government in 2014 in the face of stiff industry opposition. As reported by Medscape Medical News,Mexico had the highest consumption of SSBs in the world at the time, at 43 gallons per person per year.

And the rate of type 2 diabetes in Mexico "currently ranks among the highest in the world," observe the authors of this new modeling exercise, led by Kirsten Bibbins-Domingo, MD, PhD, MAS, department of medicine, University of California, San Francisco.

They estimate that a 10% reduction in SSB intake, which is at the lower end of the projected estimates of the impact of the Mexican soda tax, could result in almost 200,000 fewer cases of diabetes and almost 20,000 fewer deaths, as well as cost savings of almost one billion international dollars over 10 years.

Their work was published in PLOS Medicine on November 1.

Dr Bibbins-Domingo and colleagues say: "Mexico's SSB consumption has increased in recent years such that SSB calories now account for a substantial proportion of overall caloric intake. Our population modeling of CVD and diabetes [there] suggests that if Mexico's SSB tax leads to populationwide reductions in SSB intake…the policy will have a profound impact on disease burden."

Little Is Known About Longer-Term Impact of SSB Tax

The researchers decided to perform their study to generate estimates of the longer-term impact of the Mexican soda tax, which currently are unknown — they adapted the Cardiovascular Disease Policy Model, which is a computer-simulation Markov model of the incidence, prevalence, mortality, and costs of CVD-related conditions.

Using estimates generated from the Framingham Heart Study Original Cohort and Offspring Cohort data, it determines the level of risk among adults without CVD aged 35 to 94 years, taking into account age, sex, systolic blood pressure, body mass index, HDL-cholesterol level, LDL-cholesterol level, smoking, and type 2 diabetes mellitus.

To apply the model to the Mexican population, the researchers obtained demographic data and age- and sex-specified estimates of CVD risk factors among adults there. In addition, in-hospital CVD events, deaths, and case fatality rates in 2010 were estimated, and the annual direct per-patient healthcare costs were calculated.

Data from the 2006 Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición) was used to determine the daily caloric intake from SSBs, while the impact of SSBs on CVD risk factors was estimated from a review of epidemiologic studies.

Finally, the team examined the likely impact of the 10% excise tax on SSB consumption. As previously reported by Medscape Medical News, the first year after the tax was imposed, the average monthly purchases of sugary drinks fell by 6%, reaching a decrease of 12% by December 2014.

As this is in line with previous estimates that the tax would lead to a decrease in SSB consumption of 10% to 13%, the primary analysis assumed a 10% decrease in SSB consumption sustained over 10 years, with 39% of calories derived from SSBs replaced by those from other sources.

In addition, an analysis assuming a 20% reduction in SSB intake was performed.

The researchers determined that, in 2012, men in Mexico consumed an average of 1.24 servings of SSBs per day and women consumed an average of 0.86 servings. No change in SSB consumption would therefore result in 3.9 million new cases of type 2 diabetes and 1.2 million CVD deaths between 2013 and 2022 among adults aged 35 to 94 years.

A populationwide reduction in SSB intake of 10% would lead to a reduction in new cases of type 2 diabetes of 189,300 over the same time period, alongside 20,400 fewer strokes and myocardial infarctions and 18,900 fewer deaths. The greatest impact would be seen in individuals aged 35 to 44 years.

This reduction in disease burden would result in a projected total savings in direct healthcare costs related to diabetes of 983 million international dollars over 10 years.

And if the reduction in SSB consumption reached 20%, there would be 368,600 fewer incident cases of type 2 diabetes between 2013 and 2022, achieving a direct healthcare cost saving of 1916 million international dollars over 10 years.

Taxation Is Just One Part of the Equation

The researchers write: "Though our findings suggest that the tax could bring considerable health and economic benefits, large and sustained declines in SSB consumption will likely require a combination of strategies including mass-media campaigns, healthy-food-consumption subsidies, nutritional labeling, and marketing restrictions, in addition to taxation.

"The Mexican government has implemented other initiatives that could enhance the effects of the tax, including school-based guidelines for serving healthy foods and beverages, mandatory front-of-package labeling, and regulations around marketing foods and beverages to children," they note.

And there are plans to allocate a portion of SSB tax revenue to schemes aimed at preventing and controlling diabetes, "as well as programs aimed at increasing access to drinkable water in schools and public spaces (including installation and maintenance of drinking water fountains) and decreasing undernutrition, which could magnify the health benefits," they conclude.

The research was supported by the Fogarty International Center of the National Institutes of Health and by a grant for collaborative projects from the University of California Institute for Mexico and the United States and the National Council of Science and Technology Mexico. The authors have reported no relevant financial relationships.

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PLoS Med. 2016;13:e1002158. Article

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