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Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings.In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers).Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs.The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs.Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.

Using nationally representative data from 40 low- and middle-income countries, the authors find very low use of important CVD preventive medications, including blood pressure lowering drugs, statins, and aspirin.

Summary Background Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment. Methods We did a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based on population-level monitoring indicators recommended in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. Surveys were included if they were done in 2008 or after in an LMIC, as classified by the World Bank in the year the survey was done; were nationally representative; had individual-level data; contained a diabetes biomarker (fasting glucose, random glucose, or glycated haemoglobin); and had data on one or more diabetes treatments. Our sample included non-pregnant individuals with an available diabetes biomarker who were at least 25 years of age. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographical region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, body-mass index, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. Findings The final pooled sample from the 55 LMICs included 680 102 total individuals and 37 094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9·0% (95% CI 8·7–9·4), with 43·9% (41·9–45·9) reporting a previous diabetes diagnosis. Overall, 4·6% (3·9–5·4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50·5% (48·6–52·5); antihypertensive medication was 41·3% (39·3–43·3); cholesterol-lowering medication was 6·3% (5·5–7·2); diet counselling was 32·2% (30·7–33·7); exercise counselling was 28·2% (26·6–29·8); and weight-loss counselling was 31·5% (29·3–33·7). Countries at higher-income levels tended to have greater coverage. Female sex and higher age, body-mass index, educational attainment, and household wealth were also associated with greater coverage. Interpretation Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, are urgent global diabetes priorities. Funding National Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy & Innovation, National Institute of Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and National Center for Advancing Translational Sciences of the National Institutes of Health.

OBJECTIVE Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15–30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5–22%) lower relative risk of glycemic control, 6% (95% CI −5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2–39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.

The Caribbean region faces a growing burden due to cancer. Urgent action needs to be taken to monitor this disease and inform measures required for prevention and control. Cancer surveillance, supported by the implementation of population-based cancer registries (PBCRs), is an important component of cancer prevention and control strategies. Yet, the ability of some Caribbean countries to implement infrastructure needed for sustainable, high-quality PBCRs remains a challenge given limitations in resources and competing health priorities. While some Caribbean cancer registries have been successful in contributing high-quality cancer data in support of national cancer control and prevention efforts, this represents coverage of only a small percentage of the Caribbean population, and these data have limited generalizability to other countries in the region. The International Agency for Research on Cancer (IARC) Caribbean Cancer Registry Hub (http:// caribbeancrh.carpha.org) is performing an important role in providing technical support, capacity building, advocacy, and research needed for strengthening cancer registration in the region. The Caribbean Hub engages high-level political and technical stakeholders, and shares appropriate and relevant resources and expertise to help health care and public health professionals and policymakers understand the importance of data generated from PBCRs for cancer control planning and monitoring. Through the provision of technical support for the implementation or strengthening of PBCRs in the region, the Caribbean Hub will support efforts being made by Caribbean countries to establish high-quality PBCRs. The Hub will continue to facilitate capacity building through training workshops and other similar activities as well as support training opportunities for cancer registries throughout the region. Research initiatives will continue to be conducted and supported by the Caribbean Hub to identify priorities and to monitor and evaluate cancer control strategies in the region. Through the work of the IARC Caribbean Cancer Registry Hub, Caribbean countries are better equipped to overcome challenges faced and strengthen cancer surveillance nationally and regionally. This is an important step towards mitigating the cancer burden and improving cancer prevention and control measures in the Caribbean.

Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. Methods In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Findings Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Interpretation Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Funding Harvard McLennan Family Fund, Alexander von Humboldt Foundation.

OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1–8.0) and of undiagnosed diabetes 4.9% (4.6–5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5–8.1), lower-middle-income economies (LMIs) 7.1% (6.6–7.6), and upper-middle-income economies (UMIs) 8.2% (7.5–9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22–1.78], LMIs 1.14 [1.06–1.23], and UMIs 1.28 [1.02–1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.

Purpose: Cancer registration is an integral part of national disease surveillance, and actions must be taken to maintain operation of such essential systems, even during concurrent public health emergencies. This abstract summaries the impact of the COVID-19 pandemic on operations of population-based cancer registries (PBCRs) in the Caribbean. Methods: In May 2020, the International Agency for Research on Cancer (IARC) issued a worldwide survey to members of the International Association of Cancer Registries (IACR) to assess the impact of the COVID-19 pandemic on PBCRs. In November, the IARC Caribbean Hub renewed this call for responses from IACR members plus additional Caribbean PBCRs. The experience of ten of thirteen registries contacted is presented. Results: Survey responses were received from PBCRs in the Bahamas, Barbados, Bermuda, Cuba, Dominican Republic, Guyana, Jamaica, Martinique, Puerto Rico, and Trinidad and Tobago. Five (50%) registries reported that the COVID-19 pandemic negatively affected operations. These same registries reported a reduction in data collection capacity ranging from 28% to 100%. Reasons for data collection disruptions included an inability to fully access physical data sources and a reduced capacity or inability to receive cancer notifications and files. Where data collection was impacted, all registries expected missing cancer cases to be registered later in the next 12-15 months. Remote working was one strategy implemented by unaffected registries. One (10%) registry reported an impact on registry financing, and two (20.0%) reported that staffing was affected. Conclusions: Half of responding Caribbean registries reported having been negatively affected by the COVID-19 pandemic, particularly regarding data collection. Improved access to physical data sources for registration activities could mitigate continuing operational challenges in the current pandemic. Accelerating the development of electronic records and direct source abstraction via remote electronic access could support continuous operation of cancer registries amidst future emergencies or operational disruptions. Citation Format: Sarah Quesnel-Crooks, Rachel Hanisch, Isabelle Soerjomataram, Brenda Edwards, Arica White, Betsy Kohler, Ann Chao, Les Mery, Glennis Andall-Brereton. Impact of the COVID-19 Pandemic on Cancer Registry Operations in the Caribbean [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 31.

Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases (‘NCD readiness indicators’ from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08–3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09–4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02–1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06–1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11–1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01–1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12–2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01–1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09–1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01–1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes. Conclusion In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries’ preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care., Author summary Why was the study done? Diseases such as high blood pressure and diabetes are becoming increasingly common in low- and middle-income countries (LMICs). Treatment for these conditions is simple and cheap. However, without treatment, sufferers are at high risk of adverse consequences, such as heart attacks and strokes. It is important therefore to be able to measure whether patients who need treatment are getting it. Currently, LMICs’ progress towards being able to treat patients with hypertension and diabetes is measured using proxies, for example, whether policies, guidelines, funding, structures, or human resources are in place. What did the researchers find? We measured whether 187,552 people with hypertension living in 43 LMICs and 40,795 people with diabetes living in 28 LMICs had their high blood pressure or diabetes treated well; i.e., they had these conditions diagnosed, treated, or controlled. We found that most proxy measures were not reflective of whether patients had their condition treated well. What do these findings mean? To judge countries’ progress towards ability to treat hypertension and diabetes requires directly assessing whether people with these diseases are getting the treatment that they need. The main limitation of the study was that a one-time measurement of blood pressure or blood glucose was used to define whether participants had high blood pressure or diabetes. To make a concrete clinical diagnosis requires more detailed investigation.

Background The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. Methods and findings We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. Conclusions The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured., Using individual participant data from a large cohort study, Jennifer Manne-Goehler and colleagues reveal poor healthcare provision for diabetes patients in 28 LMICs., Author summary Why was this study done? Diabetes is a growing problem in low-income and middle-income countries, which already carry about 75% of the global diabetes burden, but there is limited evidence to guide policymaking in these settings. Prior studies have analyzed the cascade of care for diabetes in single-country or subnational contexts, but to our knowledge there have been no prior multi-country analyses on this subject. This study analyzes nationally representative data regarding health system performance for people who have diabetes, as defined by biological criteria, across a spectrum of levels of economic development. What did the researchers do and find? We harmonized nationally representative population-based survey data from 28 low-income and middle-income countries in 4 geographic regions, and used these data to construct the diabetes care cascade stratified by individual factors and national income. In this sample of over 800,000 adults, the overall prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), of which 4.8% (95% CI: 4.5%–5.2%) was undiagnosed. In this study, we found that health system performance for diabetes showed large losses to care at the stage of detection (63.4% [95% CI: 56.7%–69.6%]) and low rates of diabetes control (22.8% [95% CI: 20.9%–24.9%]). Total unmet need for diabetes care (defined as the sum of undetected, detected but undiagnosed, diagnosed but untreated, and treated but not controlled diabetes) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was better in upper-middle-income countries, but across all World Bank income groups, only 16%–25% of those with diabetes achieved diabetes control. Increasing age, educational attainment, and overweight or obesity were associated with higher odds of being tested, treated, and achieving control. What do these findings mean? There is a large unmet need for diabetes care that reflects the need for a greater investment of health resources to strengthen systems of care for this disease. Given that diabetes is considered a tracer condition for examining health systems, these findings also indicate that many countries face challenges in achieving universal health coverage.

Between 2006 and 2016, 70% of all deaths worldwide were due to noncommunicable diseases (NCDs). NCDs kill nearly 40 million people a year globally, with almost three-quarters of NCD deaths occurring in low- and middle-income countries. The objective of this study was to assess mortality rates and trends due to deaths from NCDs in the Caribbean region.The study examines age-standardized mortality rates and 10-year trends due to death from cancer, heart disease, cerebrovascular disease, and diabetes in two territories of the United States of America (Puerto Rico and the U.S. Virgin Islands) and in 20 other English- or Dutch-speaking Caribbean countries or territories, for the most recent, available 10 years of data ranging from 1999 to 2014. For the analysis, the SEER*Stat and Joinpoint software packages were used.These four NCDs accounted for 39% to 67% of all deaths in these 22 countries and territories, and more than half of the deaths in 17 of them. Heart disease accounted for higher percentages of deaths in most of the Caribbean countries and territories (13%-25%), followed by cancer (8%-25%), diabetes (4%-21%), and cerebrovascular disease (1%-13%). Age-standardized mortality rates due to cancer and heart disease were higher for males than for females, but there were no significant mortality trends in the region for any of the NCDs.The reasons for the high mortality of NCDs in these Caribbean countries and territories remain a critical public health issue that warrants further investigation.Entre los años 2006 y 2016, las enfermedades no transmisibles (ENT) ocasionaron un 70 % de todas las muertes mundiales. Las ENT son responsables de la muerte de aproximadamente 40 millones de personas al año a nivel mundial, de las cuales casi tres cuartas partes tienen lugar en países de ingresos medianos y bajos. El objetivo de este estudio es evaluar las tasas de mortalidad y las tendencias relacionadas con las defunciones por ENT en el Caribe.En el estudio se examinan las tasas de mortalidad ajustadas por edad y las tendencias a lo largo de diez años relacionadas con la muerte por cáncer, cardiopatías, enfermedades cerebrovasculares y diabetes en dos territorios de Estados Unidos (Puerto Rico e Islas Vírgenes), así como en otros veinte países o territorios de habla inglesa o neerlandesa, empleando la información disponible más reciente que corresponde a los diez años comprendidos entre 1999 y el 2014. Para el análisis, se utilizaron los programas informáticos JointPoint y SEER*Stat.Estas cuatro ENT representan entre el 39 % y el 67 % del total de muertes en estos 22 países y territorios, y más de la mitad de las muertes en 17 de ellos. Las cardiopatías representan porcentajes mayores de muertes en la mayor parte de los países y territorios del Caribe (13 %-25 %), seguidos por el cáncer (8 %-25 %), la diabetes (4 %-21 %) y las enfermedades cerebrovasculares (1 %-13 %). Las tasas de mortalidad ajustadas por edad relacionadas con el cáncer y las cardiopatías son mayores en hombres que en mujeres, si bien no hubo en la región tendencias significativas relacionadas con la mortalidad en lo que concierne a ninguna ENT.Las causas de la elevada mortalidad por ENT en estos países y territorios del Caribe siguen siendo un grave problema de salud pública que justifica una investigación en profundidad.No período de 2006 a 2016, 70% das mortes na população mundial foram decorrentes de doenças não transmissíveis (DNTs). Cerca de 40 milhões de pessoas morrem por DNTs por ano em todo o mundo, com quase 75% das mortes ocorrendo nos países de baixa e média renda. O objetivo deste estudo foi avaliar as taxas e as tendências de mortalidade por DNTs no Caribe.Foram examinadas as taxas de mortalidade padronizadas por idade e as tendências ao longo de 10 anos da mortalidade por câncer, doença cardíaca, doença cerebrovascular e diabetes em dois territórios dos Estados Unidos (Porto Rico e Ilhas Virgens Americanas) e em 20 países ou territórios do Caribe de língua inglesa ou holandesa, com base nos últimos dados de 10 anos para o período de 1999 a 2014. Os softwares SEER*Stat e Joinpoint foram usados na análise.As quatro DNTs estudadas representaram 39% a 67% das causas de mortes nos 22 países e territórios, e foram responsáveis por mais da metade das mortes em 17 deles. A mortalidade na maioria dos países e territórios do Caribe foi maior por doença cardíaca (13% a 25%), seguida do câncer (8% a 25%), diabetes (4% a 21%) e doença cerebrovascular (1% a 13%). As taxas de mortalidade padronizadas pela idade por câncer e doença cardíaca foram maiores nos homens que nas mulheres, mas não se verificaram, na região, tendências de mortalidade significativas para qualquer uma das DNTs.A elevada mortalidade por DNTs nos países e territórios do Caribe é ainda um sério problema de saúde pública e os motivos devem ser investigados mais a fundo.

Cancer is one of the leading causes of deaths worldwide (1); in 2012, an estimated 65% of all cancer deaths occurred in the less developed regions of the world (2). In the Caribbean region, cancer is the second leading cause of mortality, with an estimated 87,430 cancer-related deaths reported in 2012 (3). The Pan American Health Organization defines the Caribbean region as a group of 27 countries that vary in size, geography, resources, and surveillance systems.* CDC calculated site- and sex-specific proportions of cancer deaths and age-standardized mortality rates (ASMR) for 21 English- and Dutch-speaking Caribbean countries, the United States, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands [USVI]), using the most recent 5 years of mortality data available from each jurisdiction during 2003-2013. The selection of years varied by availability of the data from the countries and territories in 2015. ASMR for all cancers combined ranged from 46.1 to 139.3 per 100,000. Among males, prostate cancers were the leading cause of cancer deaths, followed by lung cancers; the percentage of cancer deaths attributable to prostate cancer ranged from 18.4% in Suriname to 47.4% in Dominica, and the percentage of cancer deaths attributable to lung cancer ranged from 5.6% in Barbados to 24.4% in Bermuda. Among females, breast cancer was the most common cause of cancer deaths, ranging from 14.0% of cancer deaths in Belize to 29.7% in the Cayman Islands, followed by cervical cancer. Several of the leading causes of cancer deaths in the Caribbean can be reduced through primary and secondary preventions, including prevention of exposure to risk factors, screening, early detection, and timely and effective treatment.