Gregory Emily F, Roberto Christina A, Mitra Nandita, Edmondson Emma K, Petimar Joshua, Block Jason P, Hettinger Gary, Gibson Laura A
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Pediatr. 2025 Jan 1;179(1):46-54. doi: 10.1001/jamapediatrics.2024.4782.
Taxation of sweetened beverages is a proposed strategy to reduce excess sugar consumption. The association of such taxes with health outcomes is not well studied. Philadelphia, Pennsylvania, is the largest US city with a beverage tax.
To assess whether the 2017 Philadelphia beverage tax was associated with changes in pediatric weight outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This study used difference-in-differences models weighted by inverse probability of treatment weights to adjust for differences between youth in Philadelphia (tax exposed) and in the surrounding counties (control) on age, sex, race, ethnicity, Medicaid insurance status, health care use, and census-tract socioeconomic index. Mixed-effects linear and logistic regression models estimated differences in posttax changes in standardized body mass index (zBMI) and prevalence of obesity (a BMI 95th percentile or higher for age and sex) between Philadelphia and control. Stratified analyses assessed differences by age, sex, race, Medicaid insurance status, and baseline weight. Data came from electronic health records of a primary care network operating in the Philadelphia region. A panel analysis included youth 2 to 18 years old with 1 or more BMI measurement pretax (2014 to 2016) and 1 or more BMI measurement posttax (2018 to 2019). A cross-sectional analysis included youth 2 to 18 years old with 1 or more BMI measurement at any time from 2014 to 2019. These data were analyzed from December 2020 through July 2024.
Living in Philadelphia after implementation of the beverage tax.
zBMI and obesity prevalence.
In panel analysis of 136 078 youth, the tax was associated with a difference in zBMI change of -0.004 (95% CI, -0.009 to 0.001) between Philadelphia and the control and a 1.02 odds ratio (95% CI, 0.97-1.08) of BMIs in the 95th percentile or higher. In cross-sectional analysis of 258 584 youth, the difference in zBMI change was -0.004 (95% CI, -0.009 to 0.001) and the odds ratio of a BMI in the 95th percentile or higher was 1.01 (95% CI, 0.95-1.07). In subgroup analyses, some differences in zBMI change were evident by race, age, Medicaid insurance status, and baseline weight but these differences were small and inconsistent across samples.
These results show that 2 years after implementation, the Philadelphia beverage tax was not associated with changes in youth zBMI or obesity prevalence. Though certain subgroups demonstrated small statistically significant changes in zBMI, they are of low clinical significance.
对含糖饮料征税是一项旨在减少过量糖分摄入的提议策略。此类税收与健康结果之间的关联尚未得到充分研究。宾夕法尼亚州费城是美国征收饮料税的最大城市。
评估2017年费城饮料税是否与儿童体重结果的变化相关。
设计、背景和参与者：本研究使用倾向得分加权的差分模型，以调整费城（受税收影响）和周边县（对照）青少年在年龄、性别、种族、民族、医疗补助保险状况、医疗保健使用情况和普查区社会经济指数方面的差异。混合效应线性和逻辑回归模型估计了费城与对照地区在税后标准化体重指数（zBMI）变化和肥胖患病率（按年龄和性别计算，BMI处于第95百分位或更高）方面的差异。分层分析评估了按年龄、性别、种族、医疗补助保险状况和基线体重划分的差异。数据来自费城地区一家初级保健网络的电子健康记录。一项面板分析纳入了2至18岁的青少年，他们在税前（2014年至2016年）有1次或更多次BMI测量值，在税后（2018年至2019年）有1次或更多次BMI测量值。一项横断面分析纳入了2至18岁的青少年，他们在2014年至2019年的任何时间有1次或更多次BMI测量值。这些数据于2020年12月至2024年7月进行分析。
饮料税实施后居住在费城。
zBMI和肥胖患病率。
在对136078名青少年的面板分析中，该税收与费城和对照地区之间zBMI变化差异为-0.004（95%CI，-0.009至0.001）以及BMI处于第95百分位或更高的比值比为1.02（95%CI，0.97 - 1.08）相关。在对258584名青少年的横断面分析中[，zBMI变化差异为-0.004（95%CI，-0.009至0.001），BMI处于第95百分位或更高的比值比为1.01（95%CI，0.95 - 1.）。在亚组分析中，zBMI变化在种族、年龄、医疗补助保险状况和基线体重方面存在一些明显差异，但这些差异较小且在各样本中不一致。
这些结果表明，实施两年后，费城饮料税与青少年zBMI或肥胖患病率的变化无关。尽管某些亚组在zBMI上显示出统计学上的小幅度显著变化，但临床意义不大。
