Prevalence of Risk Factors and Lifestyle Choices Associated with Increased Cancer in Participants in Trinidad and Tobago

In the Caribbean, cancer has been identified as the second leading cause of death and has created an immense challenge for healthcare services and expenses throughout the region. According to the World Health Organization (WHO), cancer incidence will increase by 58%, from 2015 to 2035, and cancer mortality throughout this period will increase by 67%. This research project outlined the socio-demographic risk factors and lifestyle choices known to increase the risk of developing various forms of cancer that are present in the population of Trinidad & Tobago. Knowledge of these risk factors will allow members of the public to evaluate their lifestyles. Subsequently, they can determine if they are putting themselves at risk for certain malignancies, since different types of cancers have specific socio- demographic factors and lifestyle choices associated with them.

A two-year hospital based study of Lung Cancer with reference to Histological subtypes, Demograhpics, risk factors and presentng stage

Lung cancer is one of the most common cause of mortality, highly attributed to an increase in tobacco use/ cigarette smoking. It ranks amongst the top 3 causes of cancer in Trinidad and Tobagonian men. The objective of this study is to the investigate the prevalence of Lung cancer in Trinidad and Tobago, its histological subtypes, demographics, predisposing risk factors and presenting stage. Additionally, comparison is made between current Lung cancer trends and those identified from previous studies. Our current findings is a more accurate representation of local trends, which can now provide foundational data that can be used to implement better approaches in the improvement of Lung cancer care in Trinidad and Tobago.

COVID-19 and ethnicty: Does reduced responsiveness to glucocorticiods explain the more aggressive nature of disease among minorities?

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, In the United States, the age-adjusted mortality rate among Blacks is 3.8 times, Hispanics 2.5 times, and Asians 1.5 times higher than Whites. In the United Kingdom, the age-adjusted mortality rate among Blacks is 2.9 times, Pakistani and Bangladeshi 2.2 times, and South Indians 1.8 times than that of Whites. One should consider that the increased mortality seen in BAME may be a consequence of impaired glucocorticoid sensitivity stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D. This study aims to evaluate the effect, or lack thereof, of glucocorticoids on Black, Asian and Minority ethnic groups (BAME) when compared to White populations in the setting of COVID-19 treatment.

Post­World War II epidemiological transitions in Caribbean Societies: Interpretive insights based on age-associated mortality profiles

Objective: Life expectancy at birth is a robust indicator of the mortality profile in any spatial unit. The paper draws on age-associated life expectancy estimates from six Caribbean nations between 1950 and 2015 to assess variable gain in longevity of life at various stages of human lifespan and make claims about the variable impact of nation-specific sociomedical interventions as well as likely lessons to be learned. Design and Methodology: Using Mixed Methodology, secondary data are drawn from the United Nations Population Databases that reflect mortality profiles at national and regional levels. The data relate to six Caribbean nations ­ Cuba, Barbados, Jamaica, Trinidad and Tobago, Guyana and Haiti and permit the detection of changes in age-associated life expectancy over 20-year intervals including four time points ­ 1955, 1975, 1995 and 2015. Descriptive statistics are used to discern variable national trends that could be understood drawing on qualitative evidence obtained from documentary research and elite interviews. Results: Three distinct mortality profiles emerge with the most favourable being in Cuba and Barbados, the least favourable in Guyana and Haiti, and Jamaica and Trinidad and Tobago being located between the two extremes. The timing and magnitude of gains in infant, child, adult and geriatric health states can be discerned from the results. Conclusion: The paper is heuristic and constitutes a basis comparing the effectiveness of primary, secondary and tertiary health care in promoting human resilience to mortality. As such, the paper provides important ameliorative lessons that have implications for critically informing the administration of health policies.

A ten-year profile of cancer in Guyana from 2003–2012

OBJECTIVE: Only one cancer report (2000–2004) on Guyana has ever been published. We sought to establish the profile of cancers in Guyana to assist policy-makers indeveloping a comprehensive cancer programme. SUBJECTS AND METHODS: Data from 2003–2012 from the population-based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: A total of 6518 incident cancers were recorded:3956 in females and 2561 in males. Mean age of females was 55.4 years, SD 16.4 and males 62.2 years, SD 18.7 (p< 0.0001). Average annual incidence was 86.8 per 100 000 population (females 105.4, males 68.1), age standardized rate was 139.3 per 100 000 population. In females, the leading sites were breast 1074, cervix uteri 1014 and corpus uteri 325; and in males, prostate 865, colo-rectum 206 and lung 157. By ethnicity, 44.4% of cases were in Afro-Guyanese and 38.4% in Indo-Guyanese. Death occurred in 52.3% (45% of females, 65% of males), for an average annual mortality rate of 48 per 100 000 population(females 47.6 and males 43.4). Lifetime risk of developing cancer was one in eight for females and one in 16 for males. CONCLUSION: Cancers placed a significant burden on the Guyanese population during 2003–2012. Females were affected at a younger age than males. Afro-Guyanese were affected more than other ethnic groups. Significant prevention, treatment and control efforts are required to reduce the morbidity and mortality associated with cancers.

Explaining the trends in coronary heart disease mortality in Barbados: 1990–2012

OBJECTIVE: To describe the relative contributions of medical treatments and major cardiovascular risk factors to the decline in coronary heart disease (CHD) mortality from1990 to 2012 in Barbados. SUBJECTS AND METHODS: We used the IMPACT CHD mortality model to estimate the effect of improvement in uptake or efficacy of medical/surgical treatments, versus changes in major CHD risk factors on mortality trends. We obtained death data from the World Health Organization(WHO) mortality database and population denominators, stratified by age and gender from the Barbados Statistical Service. Cardiovascular risk factors and treatment data were obtained from published studies, population-based risk factor surveys, Barbados’ national myocardial infarction registry and retrospective chart reviews. RESULTS: In 1990, the age-standardized CHD mortality rate was 109.5 per 100 000, falling to 55.3 in 2012, representing a 46.1% decline in CHD deaths. This resulted in139 fewer deaths observed in 2012 versus the number expected had the rate remained as in 1990. The model indicated that 61% (n = 84) of these deaths were prevented or postponed (DPPs) because of implementation of treatment. Changes in risk factors accounted for 14% of the overall decline (19 DPPs). Improvements in cholesterol, physical inactivity, smoking and fruit/vegetable intake accounted for 51 DPPs; worsening systolic bloodpressure, diabetes and obesity levels were responsible for 32 additional deaths in 2012. CONCLUSIONS: Treatments accounted for approximately two-thirds of the mortality reduction. More effective prevention policies are urgently needed.

Trends in incidence and mortality of female breast cancer in Suriname for the period 1980–2014: Implications for the healthcare system

OBJECTIVE: The aim was to analyse current breast cancer burden in relation to demographic and socio-economic indicators. This paper presents preliminary analysis of temporal trends in incidence and mortality for 1980–2013. SUBJECTS AND METHODS: data were retrieved from the histopathology database, the mortality database and the General Bureau of Statistics. Crude five-year incidence and mortality rates were calculated and expressed per 100000 women. Data are presented with 95% confidence intervals and average annual per cent changes (AAPC) over each period. Statistical significance was tested using Chi-squared for trend. RESULTS: Breast cancer incidence increased by 48% between 1980–1984 and 2000–2004 (÷2 2.32, p = 0.0004), from 13.5 (95% CI 11.1, 15.9) to 19.9 (95% CI 17.4, 22.5). From 2005 onward, the incidence rose exponentially (÷2 48.54, p-value < 0.0000001), from 19.9 (95% 17.4, 22.5) to 48.9 (95% 45.2, 52.6). The AAPC between 1980 and 2004 was 2%, but increased to 16% between 2005 and 2014, signifying the substantial rise in incidence. The upward trend for 1980–2014 was statistically significant(÷2 399.07, p-value < 0.0000001). Breast cancer mortality increased by 80.3%, from 5.33 (95% CI 3.84, 6.82) to 10.50 (95% CI 8.56, 12.43) during the period 2000–2004, with an AAPC of 3.3% (÷2 17.71, p = 0.00003). From 2005 on, the increase was 9%, with an AAPC of 0.7% (÷2 0.40, p = 0.53). The upward trend for 1980–2013 was statistically significant (÷2 44.83, p < 0.0000001). CONCLUSION: Results show that breast cancer incidence in Suriname is increasing while mortality remains stable, suggesting improvements in diagnostic and treatment services. These results are a first step to understanding breast cancer burden and establishing an evidence-based cancer control programme.

Injuries and violence in the Caribbean: how big is the problem?

OBJECTIVE: To quantify and characterize deaths from injuries and violence in the English- and Dutch-speaking Caribbean. DESIGN AND METHODS: The most recent year of available national cause-of-death data for each country for the period 2007-2013 was selected from the CARPHA regional mortality database. An analysis of regional causes of deaths by age and gender was completed. The crude injury death rate for each country, by gender, was also calculated followed by a descriptive analysis of the type of injuries contributing to death in each country. RESULTS: In the English- and Dutch-speaking Caribbean, annual deaths from injuries accounted for 11.5% of all deaths and four times as many men as women died from an injury. Among persons aged 15-44 years, 116,931 person-years of life was lost due to injuries. More males aged 1-44 years died from violence (one in four) than from any other cause. The injury death rate and the related causes varied substantially across countries within the region. CONCLUSIONS: Understanding the current mortality profile of injury and violence in the region is critical to the development of effective and efficient interventions to address this problem. Variability of these profiles across the region suggests that more research is needed to inform development of age, gender and country-specific programmes.

Dengue deaths: length of hospital stay, haematological parameters and presence of co-morbidities

OBJECTIVE: To review the characteristics of the patients who died from dengue in Trinidad to determine if there was any association between length of hospital stay, haematological parameters and ethnicity and any association with gender and the presence of co-morbidities. DESIGN AND METHODS: A descriptive study was undertaken via a review of case notes. Four major public hospitals were included in the study to locate patients who died from dengue between 2001 and 2010. RESULTS: The duration of hospital stay until death was characterised by a mode of 3 days and a median of 4 days. Eleven patients (47.8%) had a history of diabetes and 7 (30.4%) a history of hypertension recorded in the notes. A falling platelet count was observed in 69.5% of patients. A low normal haematocrit was observed in 78.2% of cases. Analyses did not reveal a significant association between length of hospital stay and platelet levels, nor with ethnicity; neither was a significant association found between gender and the presence of co- morbidities. CONCLUSION: Morbidity and mortality from dengue continue to pose a public health problem globally. Most patients had a history of diabetes with low platelets on admission, but low to normal haematocrit throughout their stay in hospital (mode 3 days). A prospective comparison study would better explore the significance of co- morbidities and the meaning of low to normal haematocrit levels.

Ethnic and gender disparities in premature adult mortality in Belize 2008-2010

OBJECTIVE: To determine if differences exist in premature adult mortality between the four main ethnic groups in Belize, by men and women aged 15-59 years. DESIGN AND METHODS: The analysis used 2008 to 2010 mortality data (Ministry of Health, Belize) and census data (2010) stratified by age, sex, and ethnicity (Statistical Institute of Belize). Underlying cause of death was classified using ICD10, then into 3-groups: communicable diseases, non-communicable diseases and injuries. We calculated the probability of death at 5-year intervals, 15-59 years (45q15) for all deaths and for the 3-broad (and competing) mortality causes. RESULTS: The probability of death among the population 15-59 years was 18.1%, and was higher in men than in women (women 13.5%, men 22.7%). Important ethnic variation existed, with Creole and Garifuna ethnic groups having three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%). This ethnic disparity pattern existed in both sexes but was greater in men. The female probability of death in the Creole and Garifuna groups was roughly twice that of the Mayan and Mestizo groups. For males it was between three and four times higher. Violent death contributes to this difference, particularly in Creole men, where roughly 1 in 7 can expect to die a violent death before their 60th birthday. CONCLUSIONS: This study starts to identify health inequities. Targeted work to identify potential interventions aimed at reducing the excess adult mortality in the Garifuna and Creole groups is needed.

Trends in breast cancer mortality in Trinidad and Tobago--a 35-year study

BACKGROUND: Breast cancer is the most frequently diagnosed cancer among women worldwide. This study examines the breast cancer mortality patterns and trends in the Caribbean island state, Trinidad and Tobago for the 35-year period, 1970-2004. METHODS: A retrospective analysis of the trends in breast cancer mortality from 1970 to 2004 was conducted. Crude mortality per 100,000 women, age-standardized mortality using World Standard population and age-stratified mortality were calculated and comparison was made between age groups above and below 50 years. RESULTS: A general pattern of increase was observed in both crude and age-standardized mortality. The overall average crude mortality was 15.6 per 100,000 women (95% confidence interval (CI) 13.9-17.1) and the average age-standardized mortality was 18.0 per 100,000 women (95% CI 16.7-19.2). There was a pattern of increase in mortality with increasing age. The mortality rate was considerably higher for the age groups above 50 years than those less than 50 years of age both showing an upward trend over the 35-year period. CONCLUSIONS: Breast cancer mortality continued to increase over the 35-year period in Trinidad and Tobago. This study did not identify the exact reasons for this increasing trend. However, it is known that Trinidad and Tobago is becoming much more industrialized. It may be speculated that decrease in fertility rates, increase in the incidence of obesity and hormone utilization could have influenced this trend.

The prevention of COPD exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.

Rationale: Exacerbations are key drivers of morbidity and mortality in chronicobstructive pulmonary disease (COPD).Objectives: We compared the relative efficacy of the long-acting inhaledbronchodilator/anti-inflammatory combination (salmeterol/fluticasone propionate) 50/500mcg bd and the long-acting bronchodilator (tiotropium) 18mcg od in preventing exacerbations and related outcomes in moderate severe COPD Methods: 1323 patients (mean age 64yr, forced expiratory volume in 1sec 39 per cent predicted) were randomized in 2-year, double blind, double-dummy, parallel study.Measurements and Main Results: Primary endpoint was healthcare utilization exacerbation rate. Other endpoints included health status measured by St. Georges Respiratory Questionnaire (SGRQ), mortality, adverse events and study withdrawal.Probability of withdrawing from the study was 29 per cent greater with tiotropium than salmeterol/fluticasone propionate (p=0.005). The modelled annual exacerbation rate was 1.28 in the salmeterol/fluticasone propionate group and 1.32 in the tiotropium group (rate ratio 0.967 [95 per cent CI: 0.836 to 1.119]; p=0.656). The SGRQ total score was statistically significantly lower at 2 years on salmeterol/fluticasone propionateversus tiotropium (difference 2.1 units, 95 per cent CI: 0.1 to 4.0, p=0.038). Mortality was significantly lower in the salmeterol/fluticasone propionate group; 21 (3 per cent of patients in this group died compared to 38 (6 per cent) in the tiotropium group (p=0.032). Morepneumonias were reported in the salmeterol/fluticasone propionate group relative to tiotropium (p=0.008).Conclusions: We found no difference in exacerbation rate between salmeterol/fluticasone propionate and tiotropium. More patients failed to complete the study receiving tiotropium. A small statistically significant beneficial effect was found on health status, with an unexpected finding of lower deaths in salmeterol/fluticasone propionate treated patients.

COPD exacerbations: defining their cause and prevention.

Exacerbations of chronic obstructive pulmonary disease (COPD) are episodes of worsening of symptoms, leading to substantial morbidity and mortality. COPD exacerbations are associated with increased airway and systemic inflammation and physiological changes, especially the development of hyperinflation. They are triggered mainly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation. Some patients are particularly susceptible to exacerbations, and show worse health status and faster disease progression than those who have infrequent exacerbations. Several pharmacological interventions are effective for the reduction of exacerbation frequency and severity in COPD such as inhaled steroids, long-acting bronchodilators, and their combinations. Non-pharmacological therapies such as pulmonary rehabilitation, self-management, and home ventilatory support are becoming increasingly important, but still need to be studied in controlled trials. The future of exacerbation prevention is in assessment of optimum combinations of pharmacological and non-pharmacological therapies that will result in improvement of health status, and reduction of hospital admission and mortality associated with COPD.

Mortality of very-low-birth-weight infants in Jamaica

A 10-year retrospective descriptive study was conducted looking at the outcome of all neonates weighing less than 1500g admitted to the University Hospital using regression models revealed birth weight to be the only independent predictor or mortality. Further improvement in survival of these infants will be dependent on the availabilty of ventilatory and nutritional support (AU)

Prevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica

OBJECTIVE: This study was undertaken to determine the prevalence of human immunodeficiency virus-type 1 (HIV-1) infection in patients with pulmonary tuberculosis at the National Chest Hospital in Jamaica. METHODS: This retrospective study reviewed the hospital records of 537 patients admitted over a seven-year period from 1995 to 2001. We used a standardized data collection form to obtain data for sociodemographic characteristics, clinical features, signs and symptoms, laboratory diagnosis, treatment and outcome. RESULTS: We found that 11.6 percent (47/406) of the patients who met the inclusion criteria and were diagnosed as having pulmonary tuberculosis were HIV-1 seropositive. Most HIV-positive patients with tuberculosis were males, and prevalence of HIV coinfection among patients with tuberculosis was highest in patients aged 30-39 years. The mortality rate in patients with tuberculosis and HIV infection was 23.4 percent (11/47) compared to 3.9 percent (14/359;P=0.001) in HIV-negative patients. Patients were treated with standard quadruple drug therapy. No multiple drug resistance was noted in Mycobacterium tuberculosis isolates. CONCLUSIONS: The prevalence of HIV in patients with tuberculosis in Jamaica is similar to that in other developing countries, but the mortality rate is higher and this warrants prompt diagnosis of HIV infection and early institution of highly active antiretroviral therapy (AU)

Leading cause of mortality in Trinidad and Tobago, 1980, 1990 & 1998

Mortality information derived from data recorded on death certificates compromise one of the oldest and most useful measures of the health status of a country, both nationally and regionally. Ranking the most frequently occurring causes of death is a popular method of presenting mortality statistics and for illustrating the relative proportion of cause-specific mortality. This information could in turn contribute to evidence-based policy-making, to designing interventions for the control and prevention of diseases, to monitoring and evaluating the effectiveness of public health programmes and to allocating financial, human and technical resources for the prevention and control of diseases. This paper attempts to show the relative proportion of mortality using the five leading causes of death in Trinidad and Tobago in order of rank for the years 1980, 1990 and 1998. The review is limited to the general population and no attempt is made to generalize to sub-populations (AU)

Obesity: diagnosis and prescription for action in the English-speaking Caribbean

Obesity has been the silent global epidemic of the last 30 years. Almost every country that has statistics has documented a progressive, often dramatic increase. And ironically, while obesity was previously associated with perceptions of wealth and plenty, a large and increasing number of victims today are trapped in poverty and are from developing countries with high levels of poverty, particularly in Latin America and the Caribbean. But unlike AIDS, which appeared "out of the blue" and carries the stigma of both infections and fatal features, obesity, as an epidemic, has been insidious, is not infectious in the accepted sense, and leads to death indirectly and surreptitiously. It has therefore been ignored as the major public health problem that it most surely is . This paper will briefly outline the dimensions of the problem in the English-speaking Caribbean; its enormous impact on health, quality of life, morbidity, mortality, and health care costs; its major causes; and a prescription for concerted, urgent regional action (AU)

Health trends in Jamaica: significant progress and a vision for the 21st century

Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in 1900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyles diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed to support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles. (AU)

Deadly Silence

Focuses on incidence of HIV and AIDS in the Caribbean, as of Spring 2000. Infection rates in Haiti, the Dominican Republic, Guyana and the Bahamas; AIDS as a cause of death among young men; Economic impact; Public awareness and understanding; Factors that affect the region's susceptibility; Incidence in Cuba; Public health education.(AU)

Principales enfermedades infecciosas en Centroamerica durante 1998, antes y despues de Mitch / Most common infectious diseases affecting Central America during 1998, before and after Mitch

We look at the epidemiology of the most common infectious diseases that in 1998 affected the countries of Central America most seriously damaged by Hurricane Mitch: Belice, El Salvador, Guatemala, Honduras, and Nicaragua. Incidence and mortality figures and fatality rates for cholera, dengue, malaria, and leptospirosis, before and after the hurricane, come from data provided by each country's ministry of Health (AU)