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BACKGROUND: Understanding and mitigating the societal economic impact of vision impairment (VI) is important for achieving the Sustainable Development Goals. AIM: To estimate the prevalent societal economic impact of presenting VI in Trinidad and Tobago using bottom-up cost and utilisation data from the 2014 National Eye Survey of Trinidad and Tobago. METHODS: We took a societal perspective to combine comprehensive, individual-level cost and utilisation data, with population-based prevalence estimates for VI, and additional data from a contemporaneous national eyecare system survey. We included direct (medical and non-medical) and indirect (productivity loss) costs, and intangible losses in total cost estimates, presented in 2014 Trinidad & Tobago (TT) dollars and UK sterling equivalent. We considered but excluded transfer payments and dead weight losses. Sensitivity analyses explored impact on total cost of parameter uncertainty and assumptions. RESULTS: Individual utilisation and cost data were available for 65.5% (n = 2792/4263) and 59.0% (n = 2516/4263) eligible participants aged ≥40 years, respectively. Participant mean age was 58.4(SD 11.8, range 40-103) years, 56.3% were female. We estimated total societal cost of VI in 2014 at UK£365,650,241 (TT$3,842,324,655), equivalent to £675 per capita (population ≥40 years). Loss of wellbeing accounted for 73.3%. Excluding this, the economic cost was UK£97,547,222 (TT$1,025,045,399), of which indirect costs accounted for 70.5%, followed by direct medical costs (17.9%), and direct non-medical costs (11.6%). CONCLUSION: This study provides a comprehensive estimate of the economic impact of vision loss in a Caribbean country, and highlights the extent to which affected individuals and their families bear the societal economic cost of vision impairment.
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OBJECTIVE: To estimate the prevalence of self-reported Type 2 diabetes mellitus, hypertension and dyslipidaemiain a nationally representative sample of adults aged ¡Ý 40years in Trinidad and Tobago. SUBJECTS AND METHODS: The National Eye Survey of Trinidad and Tobago (NESTT) was a population-based, nationally representative cross-sectional survey conductedin 2013¨C2014. Randomized multistage cluster sampling with probability-proportionate-to-size methods was used to select 4200 people aged ¡Ý 40 years from 120 clusters. A standardized interview included socio-economic and demographic variables. Comprehensive ophthalmic examination included anthropometry with measurement of fasting blood glucose, blood pressure, capillary blood glucose,HbA1c (if diabetic) and waist circumference. RESULTS: A total of 3592 (84.6%) adults aged ¡Ý 40 years participated in a basic screening interview and 2801 (61%)had a comprehensive clinic assessment. The demographic characteristics of participants were similar to the 2011 national census. The crude prevalence of self-reported hypertension was 34.4% (95% CI: 32.8, 36%), diabetes was 21.0% (95% CI: 19.72, 22.38%) and hypercholesterolaemiawas 21.2% (95% CI: 19.7, 22.7%). Combining self-reported and newly diagnosed diabetes, prevalence increased to 23.94% (95% CI: 22.57, 25.36%). The meanHbA1c in patients with diabetes was 8.25 (SD 2.25); 43% never had a retinal examination and about one-third was onlipid-lowering therapy. CONCLUSION: The self-reported prevalence of diabetes, hypertension and dyslipidaemia in Trinidad and Tobago remains high and acceptable targets for control of diabetes and hypertension are not currently being achieved. There is a strong case for improved screening for and treatmentof risk factors in the population ¡Ý 40 years