Production of Vegetables and Artichokes Is Associated with Lower Cardiovascular Mortality: An Ecological Study.

Alberto Arnedo-Pena,Francisco Guillen-Grima,Joan Puig-Barberà,Mª Rosario Pac-Sa,Juan Bellido-Blasco,Juan Bellido-Blasco,Mªangeles Romeu-Garcia

doi:10.3390/ijerph17186583

Abstract

Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991–2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: −0.19 (95% Confidence Interval [CI] −0.31 to −0.07) and −0.42 (95% CI −0.70 to −0.15) per hectare/103 inhabitants, respectively. The SMRs for CED also decreased: −0.68 (95% CI −1.61 to −0.19) and −1.47 (95% CI −2.57 to −0.36) per hectare/103 inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.

Highlights

Mortality from cardiovascular diseases (CVD), including cerebrovascular disease (CED), is the primary cause of death in the population, and many risk factors have been identified through epidemiological and medical studies [1,2,3,4,5]
Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities
Above, foreign-born population, household income in euros, unemployment, illiterate population, Using the Directed Acyclic Graphic (DAG) [29] (Figure 2), we studied the relationship of exposure percentages of occupations in agriculture, industry, services, and construction as variables for to agricultural production with all-cause, CVD, CED, and ischaemic heart disease (IHD) mortality outcomes, and potential adjustment, and agricultural production of vegetables, artichokes, and citrus fruits per hectare per confounding factors: sex, population aged 65 years and above, foreign-born, household income, 1000 inhabitants as explicative variables

Summary

Introduction

Mortality from cardiovascular diseases (CVD), including cerebrovascular disease (CED), is the primary cause of death in the population, and many risk factors have been identified through epidemiological and medical studies [1,2,3,4,5]. CVD and CED mortalities present large geographic differences, suggesting that factors at a local level may play a role in the observed variability. To explain these differences, research on mortality in small areas is useful to generate hypotheses on potential causes or risk factors, health resource distribution, and preventive measures [6,7,8]. The first stage is the detection of local differences in CVD mortality. Public Health 2020, 17, 6583; doi:10.3390/ijerph17186583 www.mdpi.com/journal/ijerph

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