Cohort studies
A cohort study is a type of longitudinal study where persons are recruited and followed overtime to determine if they develop or die from diseases/illnesses.
These types of studies are very important to public health as they allow us to evaluate risk factors for diseases that help us to plan interventions and treatment for responding to these diseases/illnesses.
Caribbean cohort studies
Cohort studies have been conducted in the Caribbean region for some time now. Although few Caribbean population-based cohort studies exist, they have provided critical information on CVD and stroke incidence, survival, risk factors and healthcare utilization. Three major cohorts conducted in the region are described below.
St James Heart Study
Trinidad & Tobago / 10-year study
This population-based multi-ethnic sample (n=2,491) of the St James community in Port-of-Spain, Trinidad involved persons of Asian Indian, African, European and mixed ethnicity. This 10-year longitudinal study initiated in the 1970’s examined coronary heart disease (CHD) incidence and mortality risk factors.
One key finding from the study was that the risk of CHD was at least 2-fold higher in Asian Indians vs. other ethnic groups and gender and diabetes impacted CHD risk. There were no US-Caribbean comparisons.
Spanish Town Cohort (STC)
Jamaica / 8-year study
This community-based cohort in Spanish Town, Jamaica (1993-2001), conducted by UWI investigators in our group, focused on hypertension, diabetes and associated risk factors and compared US, UK, Caribbean and African populations.
Relevant to this application a comparison of STC with the Jackson Heart Study revealed differences between Caribbean and African American participants in the association between education attainment and hypertension/diabetes prevalence.
Barbados Registry of Strokes
Barbados / 3-year study
This was a population-based registry of 1,058 patients diagnosed with stroke (2001-2004). Comparative analyses have been conducted since 2006 with Caribbean immigrants enrolled in the South London stroke registry. Initial findings show poor survival for stroke patients in Barbados in comparison to Caribbean immigrants in London.
The Barbados National Registry (BNR) for Chronic Disease grew directly out of the Barbados Registry of Strokes. The BNR is now an ongoing nationally representative data collection effort comprised of three chronic disease registries: the BNR-Stroke, BNR-Heart and BNR-Cancer – a unique model for small island developing states.
It should be noted that our CRCRE Methodology / Biostatistics Core Faculty have been involved in analyses of healthcare utilization and stroke outcomes that utilized this registry.
Emerging risk factors
Despite the existence of the historical Caribbean cohorts described above, the basis for the NCD epidemic that currently exists in the Caribbean remains unclear. Many of the above studies are dated and are unable to investigate emerging risk factors for the current NCD epidemic.
Furthermore, the US-Caribbean comparisons that have been reported to date do not adequately address CVD or cancer risk factors in Black or immigrant Caribbean communities in the US. No studies in the region have extensively examined biological, social and environment/neighborhood context factors in relationship to CVD and cancer.
Our proposed cohort is designed to facilitate these analyses.