Modelling the potential impact of a sugar-sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa.

Mercy Manyema,Aviva Tugendhaft,Demetre Labadarios,Karen J Hofman,Lennert J Veerman

doi:10.1186/s12889-016-3085-y

Abstract

BackgroundStroke 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.MethodsA 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.ResultsOur 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.ConclusionsFiscal 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3085-y) contains supplementary material, which is available to authorized users.

Highlights

Stroke poses a growing human and economic burden in South Africa
The change in energy intake and body mass index (BMI) resulting from the tax have been reported previously [30]
Shifts in BMI were slightly greater in women than men on average

Summary

Introduction

Stroke poses a growing human and economic burden in South Africa. 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. Stroke is a major cause of disability and death worldwide. The Global Burden of Disease Study (GBD) shows that approximately 11.6 million cases of ischaemic stroke (65 % in low-to-middle income countries, LMICs) and 5.3 million of haemorrhagic stroke (80 % in LMICs). In 2008, a modelling study showed that 75 000 new cases of stroke occurred in that year, with a third of these being fatal within 28 days. An estimated 33 500 strokes occurred in rural South Africa in 2011 [5]

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