Disparities in cardiovascular disease among Caribbean populations: a systematic literature review.

Damian K Francis,Trevor S Ferguson,Anselm Jm Hennis,Rainford J Wilks,Nadia R Bennett,Louis W Sullivan,E Nigel Harris,Marlene My Macleish

doi:10.1186/s12889-015-2166-7

Abstract

BackgroundCardiovascular diseases (CVD) are the predominant cause of death globally. The large health disparities in the distribution of the burden of disease seen in developed and developing countries are of growing concern. Central to this concern is the poor outcome which is seen disproportionately in socially disadvantaged groups and racial/ethnic minorities. The aim of the study was to conduct a systematic literature review to investigate the nature of cardiovascular disease health disparities among Afro-Caribbean origin populations and identify current knowledge gaps.MethodsA systematic literature review including a detailed search strategy was developed to search MEDLINE and other research databases. Using an a priori protocol peer-reviewed publications and grey literature articles were retrieved and screened and relevant data extracted by two independent review authors. Thematic analysis was done according to CVD outcomes and measures of disparity including age, sex, ethnicity and socioeconomic status.ResultsThe search retrieved 665 articles of which 22 met the inclusion criteria. Most studies were conducted in the United Kingdom and centered on the prevalence of CVD by ethnicity, age and sex. An important sub-theme identified was the disparities in health service utilization/hospital admission. Coronary Heart Disease (CHD) and Peripheral Arterial Disease (PAD) were less prevalent among Afro-Caribbeans compared to Caucasian and South East Asian ethnic groups. The prevalence of CHD ranged from 0–7 % in Afro-Caribbean to 2–22 % in Caucasians. Strokes were more common among Afro-Caribbeans. There are inadequate data on morbidity and mortality from CVD, particularly across the socio-economic gradient, in Afro-Caribbean populations.ConclusionsThere are important differences in morbidity and mortality from CVD across ethnic groups. Important knowledge gaps remain in understanding the social determinants of these disparities in CVD. More research exploring these gaps by varying disparity indicators needs to be undertaken.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2166-7) contains supplementary material, which is available to authorized users.

Highlights

Cardiovascular diseases (CVD) are the predominant cause of death globally
Using the methodological framework outlined by Arskey and O’Malley [16], we examined the literature on health disparities in cardiovascular diseases limited to Englishspeaking Caribbean origin populations or Caribbean immigrants’ age 18 years and older
There remain significant knowledge gaps within the CVD literature with very few studies reporting on socioeconomic status and geographic location

Summary

Introduction

Cardiovascular diseases (CVD) are the predominant cause of death globally. The large health disparities in the distribution of the burden of disease seen in developed and developing countries are of growing concern. The growing body of literature on health disparities in CVD suggests that while there has been a steady decline in CVD mortality rates in upper income countries, disparities in the burden of CVD persist, especially with regards to ethnicity, socioeconomic status and gender [8]. In countries such as the United States, health disparities continues to be pervasive and has become a growing public health concern such that its reduction and elimination is one of the main objectives of the Healthy People 2010 and 2020 campaigns [9]. Ethnic minorities such as blacks are affected, with data from the United States and the United Kingdom showing higher all-cause mortality among blacks compared to whites [10,11,12]

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