The social determinants of diabetes and cardiovascular disease risk factors in Barbados: findings from the health of the nation study

OBJECTIVE: To describe the distribution of diabetes, hypertension and related behavioural and biological risk factors in adults in Barbados by sex, education and occupation. DESIGN AND METHODS: Multistage probability sampling was used to select a representative sample of the adult population (> 25 years). Participants were interviewed using standard questionnaires, underwent anthropometric and blood pressure measurements, and provided fasting blood for glucose and cholesterol measurements. Standard WHO Definitions were used. Data were weighted for sampling and non-response and age-adjusted for group comparisons. RESULTS: Study participation rate was 55%, with 764 women, 470 men. Prevalence of obesity was 33.8%, hypertension 40.6%, and diabetes 17.9%. Compared with women, men were less likely to be obese (prevalence ratio 0.53; 95%CI 0.42–0.67), diabetic (0.77; 0.61–0.98), or physically inactive (0.47; 0.39–0.57), but more likely to smoke tobacco (4.08; 2.48–6.69) and binge drink alcohol (4.53; 2.70–7.58). In women, higher educational level was significantly related to higher fruit and vegetable intake, more physical activity, less diabetes and less hypercholesterolaemia (p values: 0.01 – 0.04). In men, higher education was significantly related only to less smoking. Differences by occupational category were limited to smoking in men and hypercholesterolaemia in women. CONCLUSIONS: In this population, unlike in most high-income countries, sex appears to be a much stronger determinant of behavioural risk factors, and consequent obesity and diabetes, than education or occupation. These findings have major implications for meeting the commitments made in the 2011 Rio Political Declaration, to reduce health inequities.

Trends in stroke and acute myocardial infarction in Barbados, 2009–2013

OBJECTIVE: To describe trends in incidence, mortality and 28-day case fatality rate (CFR) for stroke and acute myocardial infarction (MI) in Barbados during the first 5 years of the Barbados National Registry for Chronic Non-communicable Disease (BNR). DESIGN AND METHODS: BNR data on strokes and acute MIs diagnosed nationwide were collected prospectively from data sources including public and private healthcare providers. Analyses included annual incidence and mortality rates per 100,000 (IR and MR), and 28 day post-event CFR, with 95% CI and trend estimation (fitting models to data using Poisson regression). RESULTS: Approximately 593 strokes and 349 acute MIs were registered annually with the BNR between 2009 and 2013, with a small 5-year decline in acute MI IR and a small 5-year increase in stroke IR by 2013. The MR for acute MI showed a small 5-year decline, but stroke MR increased significantly over the 5 years, from 78.9 (95%CI 68.8–90.0) in 2009 to 131.7 (118.8–145.8) in 2013 (p<0.03). Similar trends to MR were seen in CFR for both stroke and acute MI. CONCLUSION: We are cautiously optimistic about the (albeit non-significant) decline in IR, MR and CFR for acute MI, which could imply improvements in healthcare service provision. However, despite little change in stroke annual incidence, significant MR increase highlights the need for improved stroke care in Barbados. Thrombolysis for acute ischaemic stroke has only been available since the new stroke unit was implemented in late 2013; continued monitoring will allow assessment of this important initiative.

Cancer in Barbados: first year of data from the National Cancer Registry in Barbados

OBJECTIVE: To describe the most common cancers diagnosed in Barbados in 2008. DESIGN AND METHODS: All malignant neoplasms diagnosed in 2008 were ascertained by trained data abstractors via ‘hot pursuit’, mainly at the single tertiary public hospital, the Queen Elizabeth Hospital (QEH), but also from private hospital and clinics. Demographic (e.g. sex, age, vital status) and other data, including site of primary tumour, histology and treatment, were collected and abstracted directly onto laptops, using the International Agency for Research on Cancer (IARC)’s CanReg software, version 5. RESULTS: A total of 1106 persons (597 men; 509 women) were diagnosed with malignant cancers in Barbados and registered with the National Registry in 2008. Skin was the second leading site among men and women (27% of cases). With the exclusion of skin cancer, prostate and breast cancers were the principal cancers in men (204; 49%) and women (131; 34%) respectively, followed by colorectal cancers (123; 15% of cases). The third most common site for women was the uterus (40; 10%), followed by the cervix (18; 5%) and stomach (13; 3%). For men, other top sites included the lung (21; 5%), stomach (18; 4%) and pancreas (12; 3%). The age-standardised incidence rates per 100,000 population (ASRs; world standard) for prostate and breast cancer in 2008 were 113.9 and 63.5, respectively. CONCLUSION: Prostate and breast cancers were the most common cancers diagnosed in Barbados in 2008