A tax on the UK soft drinks industry introduced in 2018 may have reduced the number of under-18s having a tooth extracted due to tooth decay by 12%, research published in the open access journal BMJ Nutrition, Prevention & Health.
The fall in hospital admissions may have saved more than 5,500 hospital admissions for tooth decay alone, and the biggest reductions were in children aged up to nine.
Sugar-sweetened beverages account for about 30% of added sugars in the diet of children aged one to three years and more than 50% by late adolescence. In England, nearly 90% of all tooth extractions in young children are due to tooth decay, resulting in around 60,000 missed school days a year.
The World Health Organization has recommended a tax on sugary drinks to reduce sugar consumption, which more than 50 countries have implemented.
In March 2016, the UK government announced a levy on the soft drinks industry, or ‘sugar tax’, which aimed to reduce sugar intake by encouraging drinks manufacturers to reformulate their products. The levy was implemented in April 2018.
While the link between sugary drinks and tooth decay is well documented, no studies have used real-world data to examine the link between intake and dental health.
To address this, researchers analyzed data on hospital admissions for tooth extractions due to caries in children aged 0 to 18 in England from January 2014 to February 2020, four years before to almost two years after the levy was introduced. They looked at trends overall, as well as broken down by neighborhood deprivation and age groups.
Overall, in children aged 18 and under, there was an absolute reduction in hospital admissions of 3.7 per 100,000 population per month compared to if the soft drink levy had not occurred. This was equivalent to a relative reduction of 12% compared to the case where the levy was not introduced.
Based on a population of almost 13,000,000 children aged 0-18 in England in 2020, the researchers estimated that the reduction avoided 5,638 tooth decay admissions.
Reductions in hospital admissions were greatest in the youngest children aged 0-4 years and 5-9 years, with absolute reductions of 6.5 and 3.3 per 100,000 respectively.
Dr Nina Rogers from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, first author of the study, said: “This is an important finding as children aged five to nine are the most likely to be admitted to hospital for teeth. extractions under general anesthesia’.
No significant changes in caries admission rates were observed in older age groups of 10-14 years and 15-18 years. However, reductions in hospital admissions were seen in children living in most areas regardless of deprivation.
This is an observational study, so causality cannot be established, and the researchers acknowledge that there was no comparable control group, so they could not fully attribute changes in hospital admissions to the soft drinks levy.
In addition, they say that other national interventions, such as the sugar reduction program and mandatory nutrition labels alongside the levy, may have raised public awareness of sugar consumption and influenced buying habits.
However, they conclude that their study “provides evidence of potential benefits to children’s health from the UK soft drink industry levy beyond obesity, which it was originally developed to address”.
Tooth extraction under general anesthesia is one of the most common reasons children are admitted to hospital across the UK. This study shows that ambitious public health policies, such as a tax on sugary drinks, can have an effect on improving children’s oral health.”
Professor David Conway, co-author and professor of dental public health at the University of Glasgow
Professor Sumantra Ray, Executive Director of the NNEdPro Center for Global Nutrition and Health, said: “We welcome the publication of this research which attempts to link changes at policy level and the impact on early oral/dental health outcomes which: if unpleasant, would place a significant further burden on dental services over the course of a lifetime’.
He added: “The economic implications of this are more pronounced given the current challenges in providing widespread dental health coverage in both countries with nationalized health care systems and others. While there are methodological limitations to this study in terms of causal inference, this paper provides the basis for designing further policy-sensitive research that explores these relationships in a way that clearly links cause and effect.”
Source:
Journal Reference:
Rogers, NT, et al. (2023). Estimated impact of the UK soft drinks industry levy on children’s hospital admissions for caries exports: an interrupted time series analysis. BMJ Nutrition, Prevention & Health. doi.org/10.1136/bmjnph-2023-000714.
