Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
Division of Research, Kaiser Permanente Northern California, Oakland.
JAMA Netw Open. 2024 Jul 1;7(7):e2424822. doi: 10.1001/jamanetworkopen.2024.24822.
Levying excise taxes on sugar-sweetened beverage (SSB) distributors, which are subsequently passed on to consumers, is a policy implemented to reduce the high prevalence of cardiometabolic disease and generate public health funding. Taxes are associated with lower SSB purchases and consumption, but it is unknown whether they are associated with weight-related outcomes in youth.
To determine the association of SSB excise taxes with youth body mass index (BMI) trajectories.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from 2009 to 2020, including 6 years before tax implementation and 4 to 6 years after tax implementation. The California cities of Albany, Berkeley, Oakland, and San Francisco, which implemented SSB excise taxes, were compared against 40 demographically matched control cities in California. Participants included Kaiser Permanente members aged 2 to 19 years at cohort entry (baseline) with continuous residence in selected cities with at least 1 pretax and 1 posttax BMI recorded in their electronic health record. Data analysis was performed from January 2021 to May 2023.
Implementation of SSB excise taxes.
Centers for Disease Control and Prevention age-specific and sex-specific BMI percentiles and percentage of youth with overweight or obesity before tax implementation through 4 to 6 years after implementation were compared with control cities. Statistical analysis was conducted using the difference-in-differences (DID) method. A sensitivity analysis used the synthetic control method.
A total of 44 771 youth (mean [SD] age at baseline, 6.4 [4.2] years; 22 337 female [49.9%]) resided in the cities with SSB taxes; 345 428 youth (mean [SD] age, 6.9 [4.2] years; 171 0168 female [49.5%]) resided in control cities. There was a -1.64-percentage point (95% CI, -3.10 to -0.17 percentage points) overall difference in the mean change of BMI percentile between exposure and control cities after SSB tax implementation. There was no significant overall difference in the percentage of youth with overweight or obesity or youth with obesity compared with control cities. All DID estimates were significant for youth residing in exposure cities in terms of BMI percentile (age 2-5 years in 2017, -2.06 percentage points [95% CI, -4.04 to -0.09 percentage points]; age 6-11 years in 2017, -2.79 percentage points [95% CI, -4.29 to -1.30 percentage points]), percentages of youth with overweight or obesity (age 2-5 years, -5.46 percentage points [95% CI, -8.47 to -2.44 percentage points]; age 6-11 years, -4.23 percentage points [95% CI, -6.90 to -1.57 percentage points]), and percentages of youth with obesity (age 2-5 years; -1.87 percentage points [95% CI, -3.36 to -0.38 percentage points]; age 6-11 years, -1.85 percentage points [95% CI, -3.46 to -0.24 percentage points]). Compared with control cities, changes in mean BMI percentiles were significant for male (-1.98 percentage points; 95% CI, -3.48 to -0.48 percentage points), Asian (-1.63 percentage points; 95% CI, -3.10 to -0.16 percentage points), and White (-2.58 percentage points; 95% CI, -4.11 to -1.10 percentage points) youth. Compared with control cities, White youth in exposure cities had improvements in the percentage with overweight or obesity (-3.73 percentage points; 95% CI, -6.11 to -1.35 percentage points) and the percentage with obesity (-2.78 percentage points; 95% CI, -4.18 to -1.37 percentage points).
In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.
重要性：对含糖饮料（SSB）分销商征收消费税，随后转嫁给消费者，是一项旨在降低心血管代谢疾病高发率和筹集公共卫生资金的政策。消费税与 SSB 购买量和消费量的降低有关，但尚不清楚它们是否与年轻人的体重相关结果有关。
目的：确定 SSB 消费税与青少年体重指数（BMI）轨迹之间的关联。
设计、地点和参与者：这项队列研究于 2009 年至 2020 年进行，包括在税收实施前 6 年和税收实施后 4 至 6 年期间。与加利福尼亚州的 40 个人口匹配的对照城市相比，加利福尼亚州的奥克兰、伯克利、旧金山和奥尔巴尼等城市实施了 SSB 消费税。参与者包括 Kaiser Permanente 的成员，年龄在 2 至 19 岁之间，在选定的城市中连续居住，至少有 1 次税前和 1 次税后 BMI 记录在其电子健康记录中。数据分析于 2023 年 1 月至 5 月进行。
暴露：实施 SSB 消费税。
主要结果和措施：在税收实施前通过 4 至 6 年，与对照城市相比，比较了实施 SSB 消费税前后，特定年龄和性别特定的 BMI 百分位数以及超重或肥胖青少年的百分比。使用差异-差异（DID）方法进行统计分析。一项敏感性分析使用了合成控制法。
结果：共有 44771 名青少年（基线时的平均[标准差]年龄为 6.4[4.2]岁；22337 名女性[49.9%]）居住在有 SSB 税的城市；345428 名青少年（平均[标准差]年龄为 6.9[4.2]岁；1710168 名女性[49.5%]）居住在对照城市。在实施 SSB 税之后，暴露城市与对照城市之间的 BMI 百分位数的平均变化有-1.64 个百分点（95%CI，-3.10 至-0.17 个百分点）的总体差异。与对照城市相比，超重或肥胖青少年和肥胖青少年的比例没有显著差异。对于居住在暴露城市的青少年来说，所有 DID 估计在 BMI 百分位数（2017 年 2-5 岁，-2.06 个百分点[95%CI，-4.04 至-0.09 个百分点]；2017 年 6-11 岁，-2.79 个百分点[95%CI，-4.29 至-1.30 个百分点]）、超重或肥胖青少年的比例（2017 年 2-5 岁，-5.46 个百分点[95%CI，-8.47 至-2.44 个百分点]；2017 年 6-11 岁，-4.23 个百分点[95%CI，-6.90 至-1.57 个百分点]）和肥胖青少年的比例（2017 年 2-5 岁，-1.87 个百分点[95%CI，-3.36 至-0.38 个百分点]；2017 年 6-11 岁，-1.85 个百分点[95%CI，-3.46 至-0.24 个百分点]）都有显著差异。与对照城市相比，男性（-1.98 个百分点；95%CI，-3.48 至-0.48 个百分点）、亚裔（-1.63 个百分点；95%CI，-3.10 至-0.16 个百分点）和白人（-2.58 个百分点；95%CI，-4.11 至-1.10 个百分点）青少年的 BMI 百分位数变化有统计学意义。与对照城市相比，暴露城市的白人青少年在超重或肥胖的比例（-3.73 个百分点；95%CI，-6.11 至-1.35 个百分点）和肥胖的比例（-2.78 个百分点；95%CI，-4.18 至-1.37 个百分点）方面有所改善。
结论和相关性：在这项队列研究中，SSB 消费税与青少年 BMI 百分位数降低有关。政策制定者应考虑实施 SSB 消费税，以预防或减少儿童和青少年超重和肥胖，最终预防慢性病，特别是 12 岁以下的儿童。
