Female Gender Is a Social Determinant of XXXX in the Caribbean: A Systematic Review and Meta-Analysis.

@entity1 @entity3918 @entity6 @entity28
BACKGROUND: @entity6 ( @entity3918 ) 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 @entity6 , its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. METHODS: We 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 @entity3918 , prevalence of @entity3918 , and @entity3918 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. RESULTS: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. @entity1 were more likely to have @entity3918 , @entity28 , be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for @entity1 vs. @entity1 for @entity3918 , @entity28 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 @entity1 more likely to have better glycaemic control but only one achieved statistical significance. CONCLUSION AND IMPLICATIONS: Female gender is a determinant of @entity3918 prevalence in the Caribbean. In the vast majority of world regions @entity1 are at a similar or lower risk of type 2 @entity6 than @entity1 , even when @entity28 is higher in @entity1 . Caribbean female excess of @entity6 may be due to a much greater excess of risk factors in @entity1 , especially @entity28 . These findings have major implications for preventive policies and research.
