Basu Sanjay, Vellakkal Sukumar, Agrawal Sutapa, Stuckler David, Popkin Barry, Ebrahim Shah
Prevention Research Center; Centers for Health Policy, Primary Care and Outcomes Research; Center on Poverty and Inequality; and Cardiovascular Institute, Stanford University, Stanford, California, United States of America ; Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India.
PLoS Med. 2014 Jan;11(1):e1001582. doi: 10.1371/journal.pmed.1001582. Epub 2014 Jan 7.
Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population.
Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%-5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%-1.9%) among various Indian subpopulations over the period 2014-2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5-10.0%) and 2.5% (95% CI 1.0-2.8%) of incident type 2 diabetes from 2014-2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations.
Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations.
高收入国家已提议对含糖饮料（SSB）征税，以减少肥胖和2型糖尿病。我们试图评估这一财政策略在中等收入国家印度的潜在健康影响，在印度，含糖饮料消费存在异质性，征税后含糖饮料与其他饮料之间的替代模式各异，且人群中慢性病风险差异巨大。
利用对100,855户印度家庭进行的全国代表性调查中的消费和价格变化数据，我们首先计算了含糖饮料价格变化如何改变人均含糖饮料消费量以及与其他饮料的替代情况。然后，我们将含糖饮料销售趋势、体重指数（BMI）以及按年龄、性别、收入和城乡居住地分层的糖尿病发病率数据纳入一个经过验证的微观模拟模型，以模拟在面临20%含糖饮料消费税的印度亚人群中热量消耗、血糖负荷、超重/肥胖患病率和2型糖尿病发病率。如果含糖饮料消费继续按照长期趋势呈线性增长，预计在2014 - 2023年期间，20%的含糖饮料税将使印度各亚人群中的超重和肥胖患病率降低3.0%（95%置信区间1.6% - 5.9%），2型糖尿病发病率降低1.6%（95%置信区间1.2% - 1.9%）。然而，如果含糖饮料消费趋势加速，与行业营销模式一致，预计税收的影响效果将会增加，在2014 - 2023年期间可避免4.2%的超重/肥胖流行病例（95%置信区间2.5 - 10.0%）和2.5%（95%置信区间1.0 - 2.8%）的2型糖尿病新发病例。根据当前的消费和BMI分布，我们的结果表明，相对影响最大的预计是年轻农村男性，这与我们之前的先验假设（即城市人群将是含糖饮料税的唯一受益者）相矛盾。这种估计方法的主要局限性包括假设价格弹性中所反映的前几年消费者支出行为将反映未来消费者行为，以及用于我们计算的饮食回忆数据中消费可能存在的低报情况。
持续以高税率对含糖饮料征税可减轻印度城乡亚人群中不断上升的肥胖和2型糖尿病问题。
