Observational studyThe Lancet. Global health2026
Understanding sugar-sweetened beverage tax implementation globally: a 34-year, population-based observational study in 183 countries.
Observational study in The Lancet. Global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTaxes 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.
methodsThis 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.
findingsFrom 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]).
interpretationGlobal 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.
fundingThis work was supported by the National Institutes of Health (R01HL115189).
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