Diabetes-related inequalities in health status and financial barriers to health care access in a population-based study.

AIMS: We evaluated the relationship between diabetes, health status, household income and expenditure on health care in the general population in Trinidad. METHODS: Multistage sampling of 300 households was used to select a sample of 548 adults aged > or = 25 years. There were 64 (12%) who reported a diagnosis of diabetes. Comparison was made with 128 non-diabetic controls who were frequency matched for age and sex. RESULTS: Subjects with diabetes had lower income levels than non-diabetic controls [income < or = US dollars 533 per month for 66% diabetes cases and 48% controls, test for trend P = 0.007]. Compared with controls, subjects with diabetes were less likely to have good or very good self-rated health (diabetes 32%, controls 67%; P < 0.001), and more frequently reported long-standing illness, limitation of activities, visual impairment, or self-reported history of high blood pressure, angina or heart attack. Subjects with diabetes (11%) were less likely than controls (30%) to have private health insurance (P = 0.005). Diabetic subjects (35%) were more likely than controls (16%) to have incurred expenditure on doctors' services in the last 4 weeks (P = 0.021). CONCLUSIONS: Diabetes is associated with worse health status and more frequent expenditure on medical services but greater financial barriers to access in terms of low income and lack of health insurance. Policies for diabetes should specifically address the problem of income-related variations in risk of diabetes, health care needs and barriers to uptake of preventive and treatment services, otherwise inequalities in health from this condition may increase.

Socioeconomic inequality in blood pressure and its determinants: cross-sectional data from Trinidad and Tobago.

We evaluated income- and education-related inequalities in blood pressure, hypertension and hypertension treatment in the general population of Trinidad and Tobago. The design included survey of 300 households in north central Trinidad, including 631 adults in 2001. Measurements of blood pressure, weight, height, waist and hip circumferences, and educational attainment, household income and alcohol intake by questionnaire. The slope index of inequality (SII) was used to estimate the difference in blood pressure between those with highest, as compared to lowest, socioeconomic status. Complete measurements and questionnaires were obtained for 461 (73%) including 202 men and 259 women. In women, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -12.6, 95% confidence interval -22.6 to -2.6 mmHg (P=0.013); and -10.8 (-21.4 to -0.2) mmHg (P=0.045) by educational attainment. After additionally adjusting for body mass index, waist-hip circumference ratio and self-reported diabetes, the SII for income was -7.3 (-16.5 to 1.9) mmHg (P=0.120) and for educational attainment was -3.0 (-13.0 to 6.9) mmHg (P=0.551). In men, after adjusting for age and ethnicity, the SII for systolic blood pressure by income was -4.3 (-15.4 to 6.8) mmHg (P=0.447) and for education -8.1 (-19.0 to 2.8) (P=0.145). There is a negative association of systolic blood pressure with increasing income or education in women. This is associated with body mass index, abdominal obesity and diabetes. There is no consistent association between education or income and blood pressure in men.

Social inequalities and children's height in Trinidad and Tobago.

OBJECTIVE: The aim of the study was to report the association of socio-economic factors with child's height. DESIGN: Cross-sectional study based on a representative national sample of government schools. SETTING: Trinidad and Tobago in 1999. SUBJECTS: A total of 2608 boys and girls mean age 5.8 y, range 4.38-6.99 y and 3080 mean age 8.6 y, range 7.00-10.44 y olds. OUTCOME: Measurement of height and a questionnaire completed by parents. In the analysis height was expressed as standard deviation scores (s.d.s.) based on the British height curves (1990) or height below -1.5 s.d.s. RESULTS: Ethnicity, parental heights, birthweight, maternal age at child's birth and number of children in the family were the main factors associated with children's height. Lack of piped water supply in the home was the only socio-economic factor consistently associated with height (mean difference in s.d.s. adjusted only for age group, gender and ethnicity -0.192, 95% CI -0.257 to -0.127 and in addition adjusted for the variables listed above -0.080, 95% CI -0.141 to -0.019). Parental education, household overcrowding and employment status were weakly associated with height in the partially adjusted model only. Analysis of severe growth failure gave similar results. CONCLUSION: The impact of socio-economic factors on height is marginal in Trinidad and Tobago. As socio-economic factors may have an impact on a broad range of health indicators, height and rates of undernutrition should not be used as sole criteria for assessing progress in decreasing health differentials caused by social inequalities.

Free school meals and children's social and nutritional status in Trinidad and Tobago.

OBJECTIVE: To evaluate the provision of free school meals in Trinidad and Tobago in relation to children's social and nutritional status. DESIGN AND METHODS: Cross-sectional survey of a nationally representative sample of 66 government schools, including children in the admissions classes (aged 4 to 7 years) and classes for 'rising nines' (aged 7-10 years). Data included questionnaire details of free school meals and children's social background, and measurements of children's heights, weights and skinfold thicknesses. RESULTS: Of 6731 eligible children, data were analysed for 5688 (85%). There were 2386 (42%) children receiving free meals provided at school. At different schools the proportion of all children receiving free meals ranged from 20% to 100%, Receipt of free meals was associated with larger family size (one child, 32% received free meals; > or =6 children, 63%), lower paternal educational attainment (primary, 52% free; university, 30%), father's employment (employed, 39% free meals; unemployed >12 months, 59%) as well as maternal education and employment and household amenities. After adjusting for age, sex and ethnic group, children who received free meals were shorter (mean difference in height standard deviation score (SDS) -0.12, 95% confidence interval (CI) -0.17 to -0.06), lighter (body mass index SDS -0.21, -0.28 to -0.14) and thinner (subscapular skinfold SDS -0.13, -0.18 to -0.09). CONCLUSIONS: Free school meals were widely available, with some targeting of provision to children with less favourable social and nutritional status. Greater universality would reduce inequity, but more stringent targeting and reduction of school-level variation would increase efficiency.

Overweight, obesity and skinfold thicknesses of children of African or Indian descent in Trinidad and Tobago.

BACKGROUND: To evaluate distribution of body mass index (BMI) and subcutaneous fat in children of African or Indian subcontinent descent living in Trinidad and Tobago. METHODS: A cross-sectional survey was carried out in a nationally representative sample of 66 government schools. Measurements were made of children's heights, weights, triceps and subscapular skinfold thicknesses. Data were analysed by sex and ethnic group and comparison was made with international standards for overweight and obesity and with British (1990) reference curves for BMI. RESULTS: Data were analysed for 5688/6731 (85%) eligible children including 1934 Afro-Trinidadian, 1689 Indo-Trinidadian, and 1794 of mixed ethnicity. Afro-Trinidadian and mixed children were taller, but Indo-Trinidadian children were shorter than reference. Values for BMI were lower than reference: mean standard deviation score (SDS), (95% confidence interval) Afro-Trinidadian -0.34 (-0.39 to -0.28), Indo-Trinidadian -1.32 (-1.39 to -1.25), mixed -0.67 (-0.74 to -0.61). Overall 486 (8.5%, 7.8 to 9.3%) of children were overweight and 138 (2.4%, 2.0 to 2.9%) were obese. Triceps skinfold thickness values were lower than reference (-0.45, -0.48 to -0.42 SDS) but subscapular skinfold thicknesses were higher (0.45, 0.43 to 0.47 SDS). Higher BMI were associated with higher BMI in the child's parents, higher reported birthweight, older age of the child's mother, smaller family size, and with higher maternal educational attainment. CONCLUSIONS: Overweight was prevalent and distribution of subcutaneous fat was central. Work is needed to determine whether these findings are associated with adult patterns of fat distribution and metabolic abnormalities.

Overweight, obesity and skinfold thicknesses of children of African or Indian descent in Trinidad and Tobago

BACKGROUND: To evaluate distribution of body mass index (BMI) and subcutaneous fat in children of African or Indian subcontinent descent living in Trinidad and Tobago. METHODS: A cross-sectional survey was carried out in a nationally representative sample of 66 government schools. Measurements were made of children's heights, weights, triceps and subscapular skinfold thicknesses. Data were analysed by sex and ethnic group and comparison was made with international standards for overweight and obesity and with British (1990) reference curves for BMI. RESULTS: Data were analysed for 5688/6731 (85%) eligible children including 1934 Afro-Trinidadian, 1689 Indo-Trinidadian, and 1794 of mixed ethnicity. Afro-Trinidadian and mixed children were taller, but Indo-Trinidadian children were shorter than reference. Values for BMI were lower than reference: mean standard deviation score (SDS), (95% confidence interval) Afro-Trinidadian -0.34 (-0.39 to -0.28), Indo-Trinidadian -1.32 (-1.39 to -1.25), mixed -0.67 (-0.74 to -0.61). Overall 486 (8.5%, 7.8 to 9.3%) of children were overweight and 138 (2.4%, 2.0 to 2.9%) were obese. Triceps skinfold thickness values were lower than reference (-0.45, -0.48 to -0.42 SDS) but subscapular skinfold thicknesses were higher (0.45, 0.43 to 0.47 SDS). Higher BMI were associated with higher BMI in the child's parents, higher reported birthweight, older age of the child's mother, smaller family size, and with higher maternal educational attainment. CONCLUSIONS: Overweight was prevalent and distribution of subcutaneous fat was central. Work is needed to determine whether these findings are associated with adult patterns of fat distribution and metabolic abnormalities.

National survey of children's health in Trinidad and Tobago: results for weight, body mass index and skinfold thickness

OBJECTIVE: To measure weight for height and skinfold thickness as indicators of overweight and obesity in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. Measurements were made of children's heights, weights, triceps and subscapular skinfold thickness. Standard deviation scores (SDS) were calculated for weight and body mass index (BMI) using age and sex specific British growth reference curves for 1990 as standard. SDS for skinfolds were calculated using English children in 1990 for reference. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values, data were analysed for 6,343 children. CONCLUSIONS: The pattern of fat distribution differed from the reference population. Although values for body mass index and triceps skinfold were lower, high subscapular skinfold values suggested excess central adiposity in this population.(Au)

National survey of children's health in Trinidad and Tobago: methods and results for height

OBJECTIVE: To measure height as an indicator of nutritional status in a representative sample of primary school children in Trinidad and Tobago. DESIGN AND METHODS: A cross-sectional survey was carried out. After stratifying for county, schools were sampled with probability proportional size. In each school all children were sampled from the admission class (mean age 5.8 years) and the `rising nines' (mean age 8.6 years). Measurements were made of children's heights. In order to standardize for age, standard deviation scores (SIDS or z scores) were calculated using age and sex specific British growth reference curves for 1990 as standard. In the reference population the mean (SD) SDS is 0.0 (1.0). Results were presented by sex and ethnic group. RESULTS: Measurements were made for 6,731 children in 66 schools. After excluding missing values data were analysed for 6,343 children (3065 boys and 3278 girls). In boys the mean height SIDS in those of African descent was 0.47 (1.04), in those of Indian descent 0.24 (1.08) and in those of mixed ethnicity 0.19 (1.07). The equivalent figures for girls were 0.53 (1.10), 0.19 (1.04) and 0.29 (1.12). Height SDS were higher for children aged 5-6 years than those aged 8-9 years. CONCLUSIONS: The distribution of children's heights in Trinidad and Tobago is similar to that observed in African Caribbean and Indian origin children in Britain. Overall the results suggest that nutritional conditions are as adequate as in the reference population.(Au)