Article Text

Estimating the impact of tax policy interventions on the projected number and prevalence of adults with type 2 diabetes in Germany between 2020 and 2040
  1. Thaddäus Tönnies1,
  2. Christin Heidemann2,
  3. Rebecca Paprott2,
  4. Esther Seidel-Jacobs1,
  5. Christa Scheidt-Nave2,
  6. Ralph Brinks1,3,4,
  7. Annika Hoyer4
  1. 1Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  2. 2Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
  3. 3Chair for Medical Biometry and Epidemiology, Witten/Herdecke University, Faculty of Health/School of Medicine, Witten, Germany
  4. 4Department of Statistics, Ludwig Maximilians University Munich, Munich, Germany
  1. Correspondence to Dr Thaddäus Tönnies; thaddaeus.toennies{at}


Introduction As a population-wide intervention, it has been proposed to raise taxes on unhealthy products to prevent diseases such as type 2 diabetes. In this study, we aimed to estimate the effect of tax policy interventions in 2020 on the projected prevalence and number of people with type 2 diabetes in the German adult population in 2040.

Research design and methods We applied an illness-death model and the German Diabetes Risk Score (GDRS) to project the prevalence and number of adults with type 2 diabetes in Germany under a base case scenario and under a tax policy intervention scenario. For the base case scenario, we assumed constant age-specific incidence rates between 2020 and 2040. For the intervention scenario, we assumed a 50% price increase for sugar-sweetened beverages, tobacco and red meat products in the year 2020. Based on price elasticities, we estimated the impact on these risk factors alone and in combination, and calculated subsequent reductions in the age-specific and sex-specific GDRS. These reductions were used to determine reductions in the incidence rate and prevalence using a partial differential equation.

Results Compared with the base case scenario, combined tax interventions in 2020 resulted in a 0.95 percentage point decrease in the prevalence of type 2 diabetes (16.2% vs 17.1%), which corresponds to 640 000 fewer prevalent cases of type 2 diabetes and a relative reduction by 6%.

Conclusions Taxation of sugar-sweetened beverages, tobacco products and red meat by 50% modestly lowered the projected number and prevalence of adults with type 2 diabetes in Germany in 2040. Raising taxes on unhealthy products as a stand-alone measure may not be enough to attenuate the future rise of type 2 diabetes.

  • diabetes mellitus
  • type 2
  • diet
  • smoking
  • primary prevention

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  • RB and AH contributed equally.

  • Contributors TT analyzed the data and wrote the manuscript. RP contributed to the analysis and discussion and reviewed the manuscript. CH and CS-N contributed to the discussion and reviewed the manuscript. ES-J researched data, contributed to the discussion and reviewed the manuscript. RB and AH are the initiators of the project and contributed to all aspects of the study. RB and AH contributed equally to this work. All authors revised the manuscript for critically important content and approved the final version of the manuscript.

  • Funding This study was supported by the German Federal Ministry of Health as part of the project ‘Establishing a national diabetes surveillance at the Robert Koch Institute’ in Berlin (grant no. GE20150323).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. We only used data on an aggregated level. The data are available from this manuscript and the sources referenced in the ‘Research design and methods’ section.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.