巴西对含糖饮料征收 20%和 30%的从价消费税后肥胖症发病率和成本的估计降幅:模型研究。

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-07-17 eCollection Date: 2024-07-01 DOI:10.1371/journal.pmed.1004399
Ana Basto-Abreu, Rossana Torres-Alvarez, Tonatiuh Barrientos-Gutierrez, Paula Pereda, Ana Clara Duran
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引用次数: 0

摘要

背景:饮用含糖饮料(SSB)与肥胖、代谢性疾病和医疗成本增加有关。鉴于其对健康的影响,世界卫生组织(WHO)建议各国对含糖饮料征税。在过去 10 年中,巴西的肥胖症发病率几乎翻了一番,但巴西政府却在 2016 年将现有的联邦 SSB 税削减至目前的 4%。自 2022 年以来,巴西参议院一直在讨论对固体饮料征收 20% 税收的法案。为了模拟巴西增加对固体饮料征税的潜在影响,我们旨在估算固体饮料的价格弹性,以及新的20%或30%的固体饮料消费税对消费、肥胖患病率和成本节约的潜在影响:利用 2017/2018 年巴西家庭预算调查(POF)中的家庭购买数据,我们估算了常数弹性回归。我们对所有饮料类别的收入水平采用了对数-对数规格:(1)加糖饮料;(2)酒精饮料;(3)无糖饮料;(4)低热量或人工加糖饮料。我们利用 2017/2018 年收集的 24 小时膳食回忆数据估算了全国成人对每类饮料的基线摄入量。以第一组为征税饮料,我们将价格弹性和交叉价格弹性应用于基线摄入量数据,得到了热量摄入量的变化。热量减少被引入个人动态模型,以估算体重和肥胖率的变化。考虑到肥胖病例减少成本的时间滞后性,在干预的前 3 年中没有建立成本节约效益模型。我们用 7 年中肥胖病例的减少量乘以人均肥胖成本,来预测因征收甜饮料税而节省的成本。收入最低的三等分人群的 SSB 价格弹性(-1.24)高于收入最高的三等分人群(-1.13),交叉价格弹性表明牛奶、水和 100% 果汁对 SSB 的替代作用较弱。我们估计,征收 20% 的消费税后,每人每天的热量变化为-17.3 千卡,征收 30% 的消费税后,每人每天的热量变化为-25.9 千卡。征收 20% 的消费税十年后,肥胖症发病率预计将降低 6.7%;征收 30% 的消费税则将降低 9.1%。在 20% 和 30% 的税率下,这些减少分别转化为-280 万和-380 万肥胖病例,在 20% 和 30% 的税率下,10 年内肥胖成本分别减少 133 亿美元和 179 亿美元。研究的局限性包括使用量化分布法调整自我报告的基线体重和身高,这可能不足以纠正报告偏差;此外,体重、身高和体育活动被假定为随着时间的推移保持稳定:结论:在巴西现行联邦税的基础上增加 20% 至 30% 的消费税有助于减少超加工饮料、空热量和体重的消耗,同时避免与健康相关的巨额成本。鉴于巴西最近削减了 SSB 税,修订和实施消费税的计划可能会对巴西人民有益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Estimated reduction in obesity prevalence and costs of a 20% and 30% ad valorem excise tax to sugar-sweetened beverages in Brazil: A modeling study.

Background: The consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings.

Methods and findings: Using household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time.

Conclusions: Adding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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