Sugar Sweetened Beverages Attributable Disease Burden and the Potential Impact of Policy Interventions: A Systematic Review of Epidemiological and Decision Models

Background: Around 184 000 deaths per year could be attributable to sugar sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. Methods: We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. We excluded studies published before 2003, cost of illness studies and economic evaluations based on individual patient data. Results: We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high income countries and 57.5% considered a health system perspective. The most common model’s outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either wholly through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -like obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% in selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), being taxes the most frequent (75%). Conclusions: There is a wide range modelling approaches with different complexity and information requirements to evaluate the burden of disease attributable to SSB. The majority consider the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could generate useful information for decision makers and the general population to promote the deeper implementation of policies to diminish SSB consumption.