title: 30 Year patterns of mortality in Tobago, West Indies, 1976-2005: impact of glucose intolerance and alcohol intake.
abstract: OBJECTIVE
  To determine the main predictors of all-cause and cardiovascular (CV) mortality in a rural West Indian population in Plymouth, Tobago over 30 years.
  
  
  METHODS
  Questionnaire survey for CV risk factors and alcohol consumption patterns administered at baseline in 1976 with 92.5% response rate. 831/832 patients were followed up until 2005 or death.
  
  
  RESULTS
  Hypertension (>140/90 mm Hg) was prevalent in 48% of men and 44% of women, and 21% of men and 17% of women had diabetes. Evidence showed most predictors for all cause and cardiovascular mortality having the main effects at ages <60 years, (p-value for interaction<0.01) but no risk factors having sex-specific effects on mortality. The main predictors of all-cause mortality at age <60 years in the fully adjusted model were high sessional alcohol intake (hazard ratio (HR) 2.04, 95% CI 1.10-3.80), severe hypertension >160/95 mm Hg (HR 1.68, 95% CI 1.09-2.60), diabetes (HR 3.28, 95% CI 1.89-5.69), and BMI (HR 1.04, 95% CI 1.00-1.07). The main predictors of cardiovascular mortality were similar in the fully adjusted model: high sessional alcohol intake (HR 2.47 95% CI 1.10-5.57), severe hypertension (HR 2.78 95% CI 1.56-4.95), diabetes (HR 3.68 95% CI 1.77-7.67) and additionally LVH, (HR 5.54 95% CI 1.38-22.26), however BMI did not show independent effects. For men, high sessional alcohol intake explains 27% of all cause mortality, and 40% of cardiovascular mortality at age <60 yrs. In adults aged <60 years, the attributable risk fraction for IGT/Diabetes and all cause mortality and cardiovascular mortality is 28% in women vs. 11% in men, and 22% in women vs. 6% in men respectively.
  
  
  CONCLUSIONS
  In this Afro-Caribbean population we found that a major proportion of deaths are attributable to high sessional alcohol intake (in males), diabetes, and hypertension and these risk factors primarily operate in those below 60 years.
authors.affiliation: Division of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. mariam.molokhia@lshtm.ac.uk
authors.forename: Mariam
authors.initials: M
authors.lastname: Molokhia
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.forename: Alan Leslie
authors.initials: AL
authors.lastname: Patrick
authors.forename: Paul
authors.initials: P
authors.lastname: McKeigue
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000401:mortality*; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D018149:Glucose Intolerance / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014300:Trinidad and Tobago / Q000453:epidemiology; D055815:Young Adult