Examining sociocultural factors influencing disparities in chronic liver diseases within Afro-Caribbean diaspora communities
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Abstract
BACKGROUND: Chronic liver diseases (CLD) are a leading cause of global mortality. Several risk factors linked to the etiology of CLD, such as type 2 diabetes, obesity, and alcohol use disorder, disproportionately affect certain racial and ethnic minority groups. Evidence from related literature provides clues that structural and social determinants of health contribute to these communities having poorer health outcomes. The intersectionality of Afro-Caribbean identity means that many social and cultural factors affect this diaspora, but little is currently understood about their specific relation to CLD in this community. The present study aimed to identify these factors and examine whether notable differences existed when compared by age, country of birth, and gender.
METHODS: A one-time survey was administered in English via an interview or was self-administered online to 237 eligible Afro-Caribbean adult participants. The survey assessed demographics, health history, lifestyle factors, cultural perceptions, and health-related behaviors using a combination of Likert-scale, open-ended, and multiple-choice questions. Quantitative survey data was pre-coded within REDCap and analyzed using STATA. Frequencies were converted to percentages for categorical variables, and median and interquartile range (IQR) were assessed for continuous variables. A rudimentary qualitative analysis was done to identify major themes in the qualitative data.
RESULTS: We identified the following key factors among the participants from quantitative analysis: low awareness and disease knowledge, alcohol misuse, infrequent exercise, poor diet, and history of chronic health conditions (asthma, obesity, diabetes, and hypertension). Additionally, significant differences were identified among certain of these factors by gender and country of birth. Prevailing themes were also identified within participant responses about factors they thought were relevant to cultural perceptions and perceived barriers around CLD in their communities. These include alcohol/drug misuse, poor diet, lack of exercise, obesity, low awareness and health knowledge, social stigma, shame, medical mistrust, lack of financial resources and healthcare access, fear of diagnosis, religious/spiritual beliefs, and tendency to use alternative medicine.
CONCLUSION: Sociocultural factors are important targets to address disparities in CLD facing the Afro-Caribbean diaspora. Future investigation of the factors identified by this study and how they may compare within specific Afro-Caribbean culture groups are necessary to aid in elucidating the role they play and the steps that can be taken to manage them strategically.
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2025