BACKGROUND Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category), £0.18 per litre for drinks with 5 to 8 g sugar per 100 mL (low levy category), and no charge for drinks with less than 5 g sugar per 100 mL (no levy category). Fruit juices and milk-based drinks are exempt. We measured the impact of the SDIL on price, product size, number of soft drinks on the marketplace, and the proportion of drinks over the lower levy threshold of 5 g sugar per 100 mL. METHODS AND FINDINGS We analysed data on a total of 209,637 observations of soft drinks over 85 time points between September 2015 and February 2019, collected from the websites of the leading supermarkets in the UK. The data set was structured as a repeat cross-sectional study. We used controlled interrupted time series to assess the impact of the SDIL on changes in level and slope for the 4 outcome variables. Equivalent models were run for potentially levy-eligible drink categories ('intervention' drinks) and levy-exempt fruit juices and milk-based drinks ('control' drinks). Observed results were compared with counterfactual scenarios based on extrapolation of pre-SDIL trends. We found that in February 2019, the proportion of intervention drinks over the lower levy sugar threshold had fallen by 33.8 percentage points (95% CI: 33.3-34.4, p < 0.001). The price of intervention drinks in the high levy category had risen by £0.075 (£0.037-0.115, p < 0.001) per litre-a 31% pass through rate-whilst prices of intervention drinks in the low levy category and no levy category had fallen and risen by smaller amounts, respectively. Whilst the product size of branded high levy and low levy drinks barely changed after implementation of the SDIL (-7 mL [-23 to 11 mL] and 16 mL [6-27ml], respectively), there were large changes to product size of own-brand drinks with an increase of 172 mL (133-214 mL) for high levy drinks and a decrease of 141 mL (111-170 mL) for low levy drinks. The number of available drinks that were in the high levy category when the SDIL was announced was reduced by 3 (-6 to 12) by the implementation of the SDIL. Equivalent models for control drinks provided little evidence of impact of the SDIL. These results are not sales weighted, so do not give an account of how sugar consumption from drinks may have changed over the time period. CONCLUSIONS The results suggest that the SDIL incentivised many manufacturers to reduce sugar in soft drinks. Some of the cost of the levy to manufacturers and importers was passed on to consumers as higher prices but not always on targeted drinks. These changes could reduce population exposure to liquid sugars and associated health risks.

中文翻译：

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英国软饮料行业税的宣布和实施对 2015-19 年英国含糖量、价格、产品大小和可用软饮料数量的影响：受控中断时间序列分析。

背景技术膳食糖，尤其是液体形式的糖，会增加龋齿、肥胖和2型糖尿病的风险。英国软饮料行业税 (SDIL) 于 2016 年 3 月宣布，并于 2018 年 4 月实施，对每 100 毫升含糖量超过 8 克的饮料（高税类别）每升 0.18 英镑向制造商和进口商收取每升 0.24 英镑的费用每 100 毫升含 5 至 8 克糖的饮品（低征税类别），每 100 毫升含糖少于 5 克的饮品（不征税类别）免费。果汁和牛奶饮料除外。我们测量了 SDIL 对价格、产品大小、市场上软饮料数量以及超过每 100 毫升 5 克糖的较低征收阈值的饮料比例的影响。方法和发现 我们分析了总共 209 个数据，2015 年 9 月至 2019 年 2 月期间 85 个时间点对软饮料的 637 项观察，从英国主要超市的网站收集。数据集被构造为重复的横断面研究。我们使用受控中断时间序列来评估 SDIL 对 4 个结果变量的水平和斜率变化的影响。对可能符合征税条件的饮料类别（“干预”饮料）和免税果汁和牛奶饮料（“控制”饮料）运行了等效模型。将观察到的结果与基于预 SDIL 趋势外推的反事实情景进行比较。我们发现，在 2019 年 2 月，干预饮料超过低征糖阈值的比例下降了 33.8 个百分点（95% CI：33.3-34.4，p < 0.001）。高税类干预饮料的价格每升上涨了 0.075 英镑（0.037-0.115 英镑，p < 0.001）——通过率提高了 31%——而低税类干预饮料的价格和无税类干预饮料的价格上涨了分别下降和上升的幅度较小。虽然在 SDIL 实施后品牌高征费和低征费饮料的产品尺寸几乎没有变化（分别为 -7 毫升 [-23 至 11 毫升] 和 16 毫升 [6-27 毫升]），但产品尺寸的变化很大自有品牌饮料，高税饮料增加 172 毫升（133-214 毫升），低税饮料减少 141 毫升（111-170 毫升）。实施 SDIL 后，在宣布 SDIL 时属于高税类别的可用饮料数量减少了 3 种（-6 至 12）。对照饮料的等效模型几乎没有提供 SDIL 影响的证据。这些结果不是销售加权的，所以不要说明饮料中的糖摄入量在一段时间内可能发生了怎样的变化。结论 结果表明，SDIL 激励了许多制造商减少软饮料中的糖分。对制造商和进口商征税的部分成本以更高的价格转嫁给消费者，但并不总是针对目标饮料。这些变化可以减少人们对液态糖的接触和相关的健康风险。对制造商和进口商征税的部分成本以更高的价格转嫁给消费者，但并不总是针对目标饮料。这些变化可以减少人们对液态糖的接触和相关的健康风险。对制造商和进口商征税的部分成本以更高的价格转嫁给消费者，但并不总是针对目标饮料。这些变化可以减少人们对液态糖的接触和相关的健康风险。