title: Modelling the potential impact of a sugar-sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa.
abstract: Stroke poses a growing human and economic burden in South Africa. Excess sugar consumption, especially from sugar-sweetened beverages (SSBs), has been associated with increased obesity and stroke risk. Research shows that price increases for SSBs can influence consumption and modelling evidence suggests that taxing SSBs has the potential to reduce obesity and related diseases. This study estimates the potential impact of an SSB tax on stroke-related mortality, costs and health-adjusted life years in South Africa.
  
  
  
  A proportional multi-state life table-based model was constructed in Microsoft Excel (2010). We used consumption data from the 2012 South African National Health and Nutrition Examination Survey, previously published own and cross price elasticities of SSBs and energy balance equations to estimate changes in daily energy intake and BMI arising from increased SSB prices. Stroke relative risk, and prevalent years lived with disability estimates from the Global Burden of Disease Study and modelled disease epidemiology estimates from a previous study, were used to estimate the effect of the BMI changes on the burden of stroke.
  
  
  
  Our model predicts that an SSB tax may avert approximately 72 000 deaths, 550 000 stroke-related health-adjusted life years and over ZAR5 billion, (USD400 million) in health care costs over 20 years (USD296-576 million). Over 20 years, the number of incident stroke cases may be reduced by approximately 85 000 and prevalent cases by about 13 000.
  
  
  
  Fiscal policy has the potential, as part of a multi-faceted approach, to mitigate the growing burden of stroke in South Africa and contribute to the achievement of the target set by the Department of Health to reduce relative premature mortality (less than 60 years) from non-communicable diseases by the year 2020.
authors.affiliation: PRICELESS-SA, MRC/Wits Rural Public, Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mercy
authors.initials: M
authors.lastname: Manyema
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Lennert J
authors.initials: LJ
authors.lastname: Veerman
authors.affiliation: PRICELESS-SA, MRC/Wits Rural Public, Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Aviva
authors.initials: A
authors.lastname: Tugendhaft
authors.affiliation: Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Cape Town, South Africa.
authors.forename: Demetre
authors.initials: D
authors.lastname: Labadarios
authors.affiliation: PRICELESS-SA, MRC/Wits Rural Public, Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Karen.Hofman@wits.ac.za.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hofman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001628:Beverages / Q000191:economics*; D019422:Dietary Sucrose / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D061213:Mortality, Premature; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D013019:South Africa / Q000453:epidemiology; D020521:Stroke / Q000191:economics* / Q000517:prevention & control; D013549:Sweetening Agents / Q000191:economics*; D013660:Taxes / Q000191:economics*
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents
keywords: Health care costs; Modelling; Mortality; Stroke; Sugar-sweetened beverages