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).