title: Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study.
abstract: BACKGROUND
  Rates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico.
  
  
  RESULTS
  We used the Cardiovascular Disease Policy Model-Mexico, a state transition model of Mexican adults aged 35-94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation. We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400-218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $769 million-$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35-44 y). This study's strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups.
  
  
  CONCLUSIONS
  Mexico's high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico's SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico's SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.
authors: Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.|Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors: Luz Maria
authors: LM
authors: Sánchez-Romero
authors: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.
authors: Joanne
authors: J
authors: Penko
authors: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.
authors: Pamela G
authors: PG
authors: Coxson
authors: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.
authors: Alicia
authors: A
authors: Fernández
authors: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.
authors: Antoinette
authors: A
authors: Mason
authors: Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors: Andrew E
authors: AE
authors: Moran
authors: Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors: Leticia
authors: L
authors: Ávila-Burgos
authors: Department of Epidemiology, Oregon State University, Corvalis, Oregon, United States of America.
authors: Michelle
authors: http://orcid.org/0000-0002-5974-3648
authors: M
authors: Odden
authors: Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors: Simón
authors: S
authors: Barquera
authors: Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.|Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America.|Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America.
authors: Kirsten
authors: K
authors: Bibbins-Domingo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001628:Beverages / Q000032:analysis* / Q000191:economics; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology*; D003198:Computer Simulation; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000453:epidemiology*; D019422:Dietary Sucrose / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D015995:Prevalence; D012307:Risk Factors; D013549:Sweetening Agents / Q000009:adverse effects / Q000191:economics; D013660:Taxes / Q000191:economics*
chemical_list: D019422:Dietary Sucrose; D013549:Sweetening Agents