title: Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country.
abstract: OBJECTIVE
  The objective of this study was to provide valid estimates of the burden of and risk factors for diabetes mellitus by sex in Jamaica, a predominantly Black, middle-income and developing country.
  
  
  METHODS
  The Jamaica Health and Lifestyle Survey 2008 examined a nationally representative sample of 2848 Jamaicans aged 15-74. Parameter estimates and 95% confidence intervals [CI] were weighted for non-response as well as age and sex of the source population. Sex differences in risk factors and diabetes prevalence, awareness, treatment and control were estimated in multivariable models. Population-attributable fractions (PAFs) of obesity on diabetes mellitus were estimated in both sexes.
  
  
  RESULTS
  The prevalence of diabetes mellitus was 7.9% (95% CI: 6.7-9.1%), significantly higher in women than men 9.3% vs. 6.4% (P = 0.02) and increasing with age. Seventy-six percentage of persons with diabetes mellitus were aware of their status; urban women and rural men were less likely to be aware. Diabetes control (43% overall) was less common in higher-income men, but more common in higher-income women. Persons without health insurance were less likely to control their diabetes. The prevalence of diabetes risk factors was higher in women than men. Increased waist circumference (≥94 cm [men]/≥80 cm [women]), overweight/obesity (body mass index ≥ 25 kg/m(2)) and low physical activity/inactivity were associated with PAFs for diabetes mellitus of 27%, 37% and 15%, respectively, in men and 77%, 54% and 24%, respectively, in women.
  
  
  CONCLUSIONS
  Prevalence of diabetes mellitus and its risk factors is high in Jamaica, especially among women, and national programmes to stem the diabetes mellitus epidemic should take these sex differences into consideration.
authors.affiliation: Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica; Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica.
authors.forename: Colette
authors.initials: C
authors.lastname: Cunningham-Myrie
authors.forename: Novie
authors.initials: N
authors.lastname: Younger-Coleman
authors.forename: Marshall
authors.initials: M
authors.lastname: Tulloch-Reid
authors.forename: Shelly
authors.initials: S
authors.lastname: McFarlane
authors.forename: Damian
authors.initials: D
authors.lastname: Francis
authors.forename: Trevor
authors.initials: T
authors.lastname: Ferguson
authors.forename: Georgiana
authors.initials: G
authors.lastname: Gordon-Strachan
authors.forename: Rainford
authors.initials: R
authors.lastname: Wilks
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001364:Awareness; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D014505:Urban Population; D055105:Waist Circumference; D016387:Women's Health; D055815:Young Adult
keywords: diabetes mellitus; obesity; population-attributable fraction; prevalence; sex; socio-economic status