BACKGROUND Overconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. METHODS A proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. RESULTS A 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. CONCLUSIONS Low-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.

中文翻译：

---

加糖饮料税对加拿大不同收入群体的健康和财务影响。

背景技术过量食用含糖饮料（SSB）会导致儿童和成人肥胖以及许多相关疾病，包括心脏病，中风，癌症和2型糖尿病。这也增加了医疗费用。在一些国家已经实行含糖饮料税，以限制糖的摄入。但是，人们担心含糖饮料税会递减。这项研究评估了模拟含糖饮料税对加拿大不同收入群体的健康和财务影响。方法基于比例多州生命表的马尔可夫模型按收入五分位数模拟了2016年加拿大人口。该模型对含糖饮料征收20％的税，并确定了与无干预措施相比对2型糖尿病和BMI相关疾病的影响。建模的特定于收入的参数包括：人口统计；交叉价格和自身价格弹性；平均BMI；含糖饮料的消费；死亡; 和疾病流行病学。结果据估计，含糖饮料税为20％，可平均减少含糖饮料的消费量约15％，而最低收入的五分之一人口则有更大的减少。估计的BMI平均下降范围为0.21至0.33，具体取决于性别和收入的五分位数；在男女收入较低的五分之一人群中，这些减少幅度更大。估计20％的含糖饮料税将在2016年加拿大成年人中避免一生约690,000 DALY；据估计，收入最低的五分之一到收入最高的五分位数分别避免了大约156,000、140,000、137,000、134,000和125,000的DALY。终生医疗保健节省估计为22.7亿美元，即2美元。收入最低的五分之一到收入最高的五分之一分别为160亿美元，21.7亿美元，21.2亿美元和19.8亿美元。2016年加拿大人口的年度税负估计为14亿加元。平均绝对税收负担估计为每人39.00至44.30美元，中等收入的五分之一人口承担着最重的绝对税收负担。收入最低的五分之一人口将在税收中支付最高比例的收入，这意味着税收是递归的。结论低收入的加拿大人将从含糖饮料税中获得最大的健康收益。但是，收入最低的五分之一人口也将支付最大比例的税收。因此，对含糖饮料征税在财务上是可以退税的，但预计将减少加拿大的健康差异。2016年加拿大人口的年度税负估计为14亿加元。平均绝对税收负担估计为每人39.00至44.30美元，中等收入的五分之一人口承担着最重的绝对税收负担。收入最低的五分之一人口将在税收中支付最高比例的收入，这意味着税收是递归的。结论低收入的加拿大人将从含糖饮料税中获得最大的健康收益。但是，收入最低的五分之一人口也将支付最大比例的税收。因此，对含糖饮料征税在财务上是可以退税的，但预计将减少加拿大的健康差异。2016年加拿大人口的年度税负估计为14亿加元。平均绝对税负估计为每人$ 39.00至$ 44.30，中等收入的五分之一人口承担最重的绝对税负。收入最低的五分之一人口将在税收中支付最高比例的收入，这意味着税收是递归的。结论低收入的加拿大人将从含糖饮料税中获得最大的健康收益。但是，收入最低的五分之一人口也将支付最大比例的税收。因此，对含糖饮料征税在财务上是可以退税的，但预计将减少加拿大的健康差异。中等收入的五分之一人口承担着最重的绝对税负。收入最低的五分之一人口将在税收中支付最高比例的收入，这意味着税收是递归的。结论低收入的加拿大人将从含糖饮料税中获得最大的健康收益。但是，收入最低的五分之一人口也将支付最大比例的税收。因此，对含糖饮料征税在财务上是可以退税的，但预计将减少加拿大的健康差异。中等收入的五分之一人口承担着最重的绝对税负。收入最低的五分之一人口将在税收中支付最高比例的收入，这意味着税收是递归的。结论低收入的加拿大人将从含糖饮料税中获得最大的健康收益。但是，收入最低的五分之一人口也将支付最大比例的税收。因此，对含糖饮料征税在财务上是可以退税的，但预计将减少加拿大的健康差异。