Abstract
BackgroundDiabetes (DM) is estimated to affect 10–15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender.MethodsWe searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models.ResultsWe found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance.Conclusion and ImplicationsFemale gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.
Highlights
The World Health Organization’s Commission on the Social Determinants of Health(CSDH) [1] drew attention to the marked inequalities in health that exist between and within populations, and focussed attention on health inequities
There were 19 articles from 12 unique studies which examined the relationship between diabetes prevalence and gender, 9 of these were based on population-based studies (Table 2).All 9 studies found a higher prevalence of DM in women than in men in 2 studies this was not statistically significant (p>0.05), while in another 3 there was no assessment of type 1 error
Four of these studies were from Jamaica, while the largest was from Cuba where women were 1.58 times more likely to have diabetes than men..There was significant heterogeneity in combining the studies with I2 values of 71% and 20% for the combined and subgroup analysis respectively
Summary
The World Health Organization’s Commission on the Social Determinants of Health(CSDH) [1] drew attention to the marked inequalities in health that exist between and within populations, and focussed attention on health inequities. Diabetes (DM) is estimated to affect between 10% -15% of the adult population in the Caribbean region[3], and to be a major contributor to premature mortality [3, 4].Where studies have been done, DM is responsible for high rates of complications, such as lower limb amputation [5]. For example, prevalence and incidence of type 2 DM is higher in those with lower education and income [6]. It has been reported that once major risk factors for type 2 DM are taken into account, in particular obesity, men have a higher incidence than women [8]. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
