英国软饮料行业征税对英格兰儿童和青少年健康及健康不平等的影响:间断时间序列分析和人口健康模型研究。

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-03-28 eCollection Date: 2024-03-01 DOI:10.1371/journal.pmed.1004371
Linda J Cobiac, Nina T Rogers, Jean Adams, Steven Cummins, Richard Smith, Oliver Mytton, Martin White, Peter Scarborough
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引用次数: 0

摘要

背景:英国软饮料行业征税(SDIL)导致家庭购买含糖饮料的数量大幅减少。在本研究中,我们探讨了这一措施对英格兰儿童和青少年的健康和健康不平等的潜在中长期影响:我们进行了一项受控间断时间序列分析,以衡量《特殊和差别待遇清单》在实施 19 个月后对英格兰每个家庭每周从软饮料中购买的糖量的影响,并按多重贫困指数 (IMD) 五分位数进行了分析。我们模拟了在 SDIL 宣布(2016 年 3 月)和实施(2018 年 4 月)后的前 10 年中,观察到的糖分减少对儿童和青少年(0 至 17 岁)体重指数 (BMI)、龋齿和质量调整生命年 (QALY) 的影响,并按 IMD 五分位数进行了分类。利用生命表模型,我们模拟了这些变化对当前出生组群预期寿命的潜在长期影响,并利用 IMD 特定生命表模型结果的回归模型,计算了 SDIL 对预期寿命不平等斜率指数 (SII) 的影响。结果发现,在英格兰,"特殊和差别化生活指数 "使每户每周从购买的饮料中摄入的糖分减少了 15 克(95% 置信区间:-10.3 到 -19.7)。该模型预测,在实施后的头 10 年中,这些糖分的减少将导致龋齿减少 3,600 例(95% 置信区间:946 至 6,330 例),被归类为超重或肥胖的儿童和青少年减少 64,100 例(54,400 至 73,400 例)。对于最贫困地区的儿童和青少年而言,购买食糖的变化和对健康的预测影响最大(第一季度:11,000 QALYs [8,370 至 14,100] ;第二季度:7,760 QALYs [8,370 至 14,100] ):7,760 QALYs [5,730 至 9,970] ),而较贫困地区的儿童和青少年受到的模拟影响可能要小得多(Q3:-1,830 QALYs [-3,260 至 -501],Q4:652 QALYs [-336 至 1,680] ,Q5:1,860 QALYs [929 至 2,890])。如果 SDIL 的模拟效果在整个生命过程中得以持续,预计不平等斜率指数将有小幅但显著的下降:女性下降 0.76%(95% 不确定区间:-0.9 至 -0.62),男性下降 0.94%(-1.1 至 -0.76):我们预测,SDIL 将导致龋齿和超重/肥胖的中期减少以及预期寿命的长期改善,预计来自更贫困地区的儿童和青少年将受益最大。这项研究提供的证据表明,英格兰儿童和青少年特殊营养需求计划可以缩小健康方面的不平等。
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Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study.

Background: The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England.

Methods and findings: We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males.

Conclusions: We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.

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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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