The ECHORN Cohort Study

Understanding Cancer, Diabetes, and Heart Disease in the Caribbean

A cohort study follows research participants for long periods of time. The ECHORN cohort study examines the individual, familial, and environmental factors associated with chronic disease in the Caribbean region. It presents a unique opportunity to identify risk and protective factors for chronic disease in a racially, socioeconomically, and linguistically diverse population over time.

Non-Communicable Diseases

Non-communicable diseases (NCDs) like cardiovascular disease, cancer, and diabetes, are the leading cause of morbidity and mortality in the Caribbean region. Rates of morbidity and mortality in the Caribbean due to NCDs are comparable to or greater than rates observed among racial and ethnic minorities on the United States mainland. A high calorie diet, smoking, and lack of exercise are some of the known risk factors for NCDs, but there is a little research related to NCD risk in the Eastern Caribbean region. There is an urgent need to better understand the prevalence of and risk and protective factors for chronic disease in the region.

Adult ECHORN Cohort Study Aims and Methods

The Adult ECHORN Cohort Study (A-ECHORN) is a community-based prospective cohort study that follows approximately 3,000 community dwelling adults 40 years of age or older who live on the islands of Puerto Rico, the US Virgin Islands, Trinidad and Tobago, and Barbados. The primary goal of the cohort study is to examine known and potential risk factors associated with the development of heart disease, cancer, and diabetes.  

Participants are asked to complete:

1.  A baseline survey with questions on socio-demographics, medical history, environmental exposures, healthcare utilization, and lifestyle behaviors;

2.  A clinical assessment, that includes a basic physical examination;

3. Laboratory testing and optional biobanking of blood specimens.

Participants are asked to return every 4-5 years to monitor changes to their health and other factors over time.

Exam 1 data were collected from 2013-2018. Data collection for Exam 2 of the Adult ECHORN Cohort is currently underway.

Pediatric Cardiovascular Risk and Intergenerational Factors

Racial/ethnic minority children, particularly Hispanic or Non-Hispanic Black children, are at high risk of developing pediatric cardiovascular risk factors including obesity, hypertension (high blood pressure), and hyperlipidemia (high cholesterol). Lack of sleep in children and adolescents exacerbates cardiovascular risk, with research showing that Hispanic and Non-Hispanic black children tend to get less sleep than their white counterparts. This disproportionate prevalence of cardiovascular risk factors amongst Hispanic and Non-Hispanic Black children will translate to worse adult cardiovascular disease disparities later on in life.

In order to address pediatric cardiovascular risk disparities, it is vital to further our understanding of how adult-child intergenerational factors contribute to the issue at hand. Few studies have examined the interactions between the adult cardiovascular risk profile (genetics, health behaviors, socioeconomic status [SES], neighborhood factors) and that of the child, despite the relationship being recognized as important. Additionally, the role of sleep quality and duration in relation to cardiovascular risk factors needs to be clarified. Enhancing our understanding of the contributors to cardiovascular risk in children will enable the development of successful interventions.

Pediatric ECHORN Aims and Methods

The P-ECHORN study focuses on childhood, familial, and environmental factors that contribute to cardiovascular risk factors, with a primary objective of characterizing intergenerational factors that contribute to pediatric cardiovascular risk. We aim to recruit 1,000 children across our 5 island sites.

As with the Adult ECHORN Cohort Study, P-ECHORN takes place at ECHORN sites across the Eastern Caribbean (Puerto Rico, US Virgin Island, Trinidad and Tobago, and Barbados). The children or grandchildren of A-ECHORN participants are invited to participate. P-ECHORN collects questionnaire data on socio-demographics, medical history, sleep behaviors, environmental exposures, healthcare utilization, and lifestyle behaviors. Participants are also asked to complete:

1. A clinical assessment, that includes a basic physical examination,

2. A laboratory test and optional biobanking of blood and saliva specimens; and

3. 7 days of sleep actigraphy.

Participants are asked to return every 2 -3 years to monitor changes to their health and other factors over time. Recruitment and enrollment is currently underway.