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.

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.

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