Undercurrents: Researchers Uncover Caribbean Health Trends

A regular Source column, Undercurrents explores issues, ideas and events developing beneath the surface in the Virgin Islands community.

Research involving the Virgin Islands and three other Eastern Caribbean locations has uncovered some noteworthy trends, including a marked prevalence of heart disease and diabetes, and has convinced researchers they need to keep digging.

The study was funded by a $5 million, five-year grant from the National Institute of Minority Health and Health Disparities, part of the National Institutes of Health. It is being conducted under the auspices of the University of the West Indies, which is gathering data in both Barbados and in Trinidad and Tobago, by the University of the Virgin Islands, and by the University of Puerto Rico. Yale University acts as the agency to coordinate the data collected from the various islands.

Some 65 people are engaged in the various aspects of research by ECHORN, or the Eastern Caribbean Health Outcomes Research Network. Their work focuses on collecting and analyzing information from thousands of people selected at random to participate in the study.

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“We have remarkable information that’s coming up already,” said Dr. Maxine Nunez, the principal investigator for the V.I. “Hypertension and diabetes are rampant” in the area.

Work is still wrapping up, but ECHORN has already applied for another five-year grant so it can continue the study.

Nunez cautioned that all the data is preliminary. Still it’s hard to ignore some of the more startling figures coming out of the study.

As of about six months ago, 23 percent of the people who had filled out a research questionnaire described themselves as having diabetes. Another 14 percent said they are pre-diabetic, meaning they are at imminent risk of developing the disease. According to the American Diabetes Association those numbers are more than double national rates. On its website, the association posts statistics from 2012 that show that nationally 9.3 percent of the population has diabetes.

Fifteen percent of the Eastern Caribbean subjects self-reported they suffer from heart disease. The national average, according to a Center for Disease Control website, is 11.3 percent.

Nunez said when the first study concludes she expects that about 350 people in the Virgin Islands will have participated. St. Thomas is already close to its goal of 250. “St. Croix had a number of setbacks” in gathering data, primarily because of staff illness, but has information from about 100 people.

“When you put all the numbers together (from all the locations) we’ll be up to about 5,000,” she said, indicating that the sample is sufficient for drawing some conclusions.

Participants in the study answer what Nunez described as an “extensive” questionnaire, covering virtually every aspect of their health history. They also submit to a physical exam, similar to one they might take in their doctor’s office, including giving a blood sample.

Some participants are also asked to give a small amount of blood to go into a biobank of blood samples being retained for future research that can include genetic tracing. Some participants are asked to give a saliva sample for the biobank.

Nunez explained that the entire project was designed to ensure participants are chosen randomly. Researchers start with a computer-generated list of phone numbers, including both land lines and cell phones. Then they contact individuals and see if they meet some basic criteria: They must be at least 40 years old, have resided on the island for at least the previous 10 years, and (to ensure their availability for follow-up study) have no plans to relocate in the next five years.

“The recruitment effort is a very time-intensive task,” Nunez said. Out of about 100 calls, she said she may recruit five people to participate. “We’re very soft on this. We make very sure they know they have the right to refuse” to participate. But, she added, “The vast majority” who meet the residency criteria “have said yes.”

Those who are asked to contribute to the biobank are also selected randomly, she said. About 100 people in the Virgin Islands have given blood samples for the biobank; another 50 participants donated saliva.

Nunez is hopeful that the work will continue under a second five-year grant.

“I can’t give a number” for the dollar amount of the grant, because that will be determined by the granting agency. But the timeline is another five years.

“We’re hoping and praying that we’ll get some word maybe next month,” she said. 

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