BACKGROUND Grocery food taxes represent a stable tax revenue stream for state and municipal government during times of adverse economic shocks such as that observed under the coronavirus disease 2019 (COVID-19) pandemic. Previous research, however, suggests a possible mechanism through which grocery taxes may adversely affect health. Our objectives are to document the spatial and temporal variation in grocery taxes and to empirically examine the statistical relationship between county-level grocery taxes and obesity and diabetes. METHODS We collect and assemble a novel national dataset of annual county and state-level grocery taxes from 2009 through 2016. We link this data to three-year, county-level estimates based on data from the Centers for Disease Control and Prevention on rates of obesity and diabetes and provide a nation-wide spatial characterization of grocery taxes and these two health outcomes. Using a county-level fixed effects estimator, we estimate the effect of grocery taxes on obesity and diabetes rates, also controlling for a subset of potential confounders that vary over time. RESULTS We find a 1 percentage point increase in grocery taxes is associated with 0.588 and 0.215 percentage point increases in the county-level obesity and diabetes rates. CONCLUSION Counties with grocery taxes have increased prevalence of obesity and diabetes. We estimate the economic burden of increased obesity and diabetes rates resulting from grocery taxes to be $5.9 billion. Based on this estimate, the benefit-cost ratio of removing grocery taxes across the United States only considering the effects on obesity and diabetes rates is 1.90.

中文翻译：

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杂货食品税和美国县肥胖率和糖尿病率。

背景技术在不利的经济冲击期间（例如在2019年冠状病毒病（COVID-19）大流行中观察到的冲击），杂货食品税为州和市政府提供了稳定的税收来源。但是，先前的研究提出了一种可能的机制，通过该机制，杂货店税可能会对健康产生不利影响。我们的目标是记录食品杂货税的时空变化，并以经验检验县级食品杂货税与肥胖症和糖尿病之间的统计关系。方法我们收集并整理了从2009年到2016年的全国县和州年度杂货税的新颖数据集。我们将此数据链接到三年，县级评估基于疾病预防控制中心关于肥胖和糖尿病的发病率数据，并提供了全国范围内食品杂货税和这两种健康结果的空间特征。使用县级固定效应估算器，我们估算了食品杂货税对肥胖率和糖尿病率的影响，还控制了随时间变化的潜在混杂因素的子集。结果我们发现，食品杂货税每增加1个百分点，县级肥胖和糖尿病的发生率就会增加0.588和0.215个百分点。结论征收食品杂货税的县肥胖症和糖尿病的患病率增加。我们估计，杂货店税导致的肥胖和糖尿病患病率上升带来的经济负担为59亿美元。根据此估算，