Understanding sugar-sweetened beverage tax implementation globally: a 34-year, population-based observational study in 183 countries

Abstract

Background: Taxes on sugar-sweetened beverages can improve public health. We aimed to characterise the extent and types of sugar-sweetened beverage taxes implemented worldwide and the national characteristics predicting implementation, such as sugar-sweetened beverage intake amounts, disease rates, or economic development. Methods: This longitudinal analysis aggregated serial global datasets (including the Global Dietary Database, Non-Communicable Diseases Risk Factor Collaboration, Global Burden of Disease study, and World Bank data) from 1990 to 2024 in 183 countries to assess sugar-sweetened beverage tax characteristics and national predictors of policy adoption. Sugar-sweetened beverage taxes for public health purposes were identified and characterised, including amounts, fiscal instruments, structures, and covered beverages. Sugar-sweetened beverage consumption, obesity and diabetes prevalence, gross domestic product (GDP), and sociodemographic index (SDI) were assessed as predictors of tax implementation using Cox proportional hazards models with time-varying covariates. Findings: From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%). Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Multivariable-adjusted predictors of tax implementation included diabetes prevalence (hazard ratio [HR]=1·22 [95% CI 1·05–1·43]), obesity prevalence (1·14 [1·00–1·29]), GDP per capita (HR per $10 000: 1·19 [1·06–1·34]), and SDI (0·70 [0·57–0·86]), but not sugar-sweetened beverage intake (0·77 [0·42–1·39]). Interpretation: Global adoption of sugar-sweetened beverage taxes has rapidly accelerated since 1990; however, there is important heterogeneity by region and tax structure, and the taxes are shaped by a country's economic capacity, social development, and health conditions. Funding: This work was supported by the National Institutes of Health (R01HL115189).