Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review

ABSTRACT

OBJECTIVES: Following the WHO Commission on the Social Determinants of Health, Caribbean countries committed to identifying and reducing health inequities (Rio Political Declaration 2011). We undertook a systematic review to determine what is known about the social distribution of diabetes (DM), its risk factors and major complications in the Caribbean. This paper describes findings on the distribution by ethnicity, education, occupation and income. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by ethnicity, income, education and occupation of known risk factors for type 2 DM, prevalence of DM, DM control or complications. Only quantitative studies were included; each was assessed for risk of bias. RESULTS: Out of 2796 unique records, 81 articles required full text review, and 29 articles met the inclusion criteria. Few studies examined DM, its risk factors or complications by education (4), income (2) or occupation (1). None described significant relationships but all had a high risk of bias. Statistically significant findings were described from Barbados, Cuba and Trinidad on the distribution of diabetes by ethnicity higher in Blacks than Whites, and in South Asians in Trinidad compared to other groups (OR 1.87, 95% CI 1.14, 3.05). CONCLUSION: Published data in the Caribbean on the social distribution of diabetes, its risk factors and complications were very limited and of overall low quality. Work to better identify health inequities in the Caribbean is required if governments are to meet their commitment to addressing them.