title: Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis.
abstract: BACKGROUND
  Diabetes (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.
  
  
  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 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  Female 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.
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: Natasha
authors.initials: N
authors.lastname: Sobers-Grannum
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: Madhuvanti M
authors.initials: MM
authors.lastname: Murphy
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: Anders
authors.initials: A
authors.lastname: Nielsen
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados; MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Guell
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: T Alafia
authors.initials: TA
authors.lastname: Samuels
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bishop
authors.affiliation: Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados; MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom; Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados.
authors.forename: Nigel
authors.initials: N
authors.lastname: Unwin
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D066252:Sociological Factors