Oct. 15, 2025
Redefining What It Means to Age
In Tobago and in veterans' clinics at home, Pitt Public Health researchers are learning how prevention and perseverance shape a healthier future.
TOPICS: Aging & Lifespan | Chronic Disease | Dementia | Education | Obesity | Research | School of Public Health
By Clare Collins, School of Public Health
The Tobago Health Study was born from a chance encounter. In the late 1990s, University of Pittsburgh epidemiologist Ronald LaPorte (1949-2021) met Trinidadian physician Alan Leslie Patrick (1940-2017) at a medical conference, and their conversation sparked a study of prostate cancer among men of African ancestry led by Pitt epidemiologist Clareann Bunker (1939-2024). Nearly 30 years later, the project has expanded to include women and a broad range of health issues, becoming one of the Caribbean's leading studies of aging.
Beginning with a narrow focus on prostate cancer, the study recruited men ages 40 and older. But as participants returned year after year and stayed involved for decades, the scope expanded. Women joined in 2019 and, today, with 80% retention rates among surviving participants, the project has become a broad resource for understanding health and aging.
“It's remarkable to see how it has transformed," says Iva Miljkovic, professor and vice chair for research, Department of Epidemiology, Pitt Public Health. "When we talk about it now, it's not just a prostate cancer study. It's a study of aging."
That shift has allowed researchers to explore new questions. "As the cohort aged, so did the questions we could ask," explains Caterina Rosano, professor of epidemiology, Pitt Public Health, and associate director for clinical translation at the joint Pitt-UPMC Aging Institute. "We now have this incredible opportunity to understand not just prostate cancer but how conditions like diabetes, hypertension and obesity influence [the] risk for dementia."
Miljkovic says the study's longevity is only possible because of the community's involvement. "Everybody knows about the study—they call it the Pitt study," she explains. "People are very loyal. They come back year after year and bring their family members. They're proud to be part of it. People will say, 'Oh, my father was in the study, my uncle, my brother.’"
The research findings reflect that commitment. Past studies led by Joseph Zmuda, associate professor of epidemiology and of human genetics, Pitt Public Health, found Tobagonian men to have lower rates of osteoporosis compared with men of European ancestry, confirming long-held assumptions about bone health. Studies of muscle quality have shown that fat infiltration in muscle, more than muscle mass itself, predicts mobility decline, diabetes and even mortality. Most recently, researchers have begun investigating cognition.
"Obesity, hypertension and diabetes—conditions on the rise across the Caribbean—are also major risk factors for dementia," Rosano says. "Yet we know very little about cognition in the region. Tobago gives us a unique chance to close that gap."
Miljkovic stresses that giving back to the community has always been a priority. "We don't just collect data and leave," she says. "We go into communities, share what we're learning and talk about prevention. That's why people continue to trust us."
Looking ahead, researchers hope to expand the work to other Caribbean islands to better understand how ethnicity and environment shape aging.
"You don't often get to see a study evolve like this," Miljkovic reflects. "Because it lasted, it became something bigger than anyone imagined—a gift for science and for Tobago."