Is agricultural engagement associated with lower incidence or prevalence of cardiovascular diseases and cardiovascular disease risk factors? A systematic review of observational studies from low- and middle-income countries

Abstract

Non-communicable diseases, such as cardiovascular diseases (CVDs), diabetes and cancer account for more than half of the global disease burden, and 75% of related deaths occur in low-and middle-income countries (LMICs). Despite large regional variations in CVD incidence and prevalence, CVDs remain the leading causes of death worldwide. With urbanisation, developing nations are undergoing unprecedented labour-force transitions out of agriculture and into types of non-agricultural employment, mainly in the industry and service sectors. There are few studies on the effect of these transitions on CVDs and CVD risk factors in LMICs. We systematically searched MEDLINE, PubMed, EMBASE and the Cochrane Library from January 1950 to January 2017 to assess the association of engaging in agriculture compared to types of non-agricultural employment (e.g. services and manufacturing) with CVD incidence, prevalence and risk factors. Studies were included if they: included participants who engaged in agriculture and participants who did not engage in agriculture; measured atherosclerotic CVDs or their modifiable risk factors; and involved adults from LMICs. We assessed the quality of evidence in seven domains of each study. Prevalence ratios with 95% confidence intervals were calculated and compared in forest plots across studies. Study heterogeneity did not permit formal meta-analyses with pooled results. There was a lack of publications on the primary outcomes, atherosclerotic CVDs (n = 2). Limited evidence of varying consistency from 13 studies in five countries reported that compared with non-agricultural workers, mainly living in urban areas, rural agriculture workers had a lower prevalence of hypertension, overweight and obesity; and a higher prevalence of underweight and smoking. High quality evidence is lacking on the associations of

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“…These factors include sociodemographic factors and a shift from a more agrarian lifestyle to industrial and service-related employment. For instance, evidence shows that, compared with non-agricultural workers mainly living in urban areas, rural agriculture workers have a lower prevalence of hypertension, overweight and obesity; and a higher prevalence of underweight and smoking in low and middle income countries ( 63 ). Overall, the findings of the current review align with existing evidence that supports the presence of an epidemiological transition in Africa over the last decade ( 64 ).…”

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“…It retains a system of participation for the elderly, which provides employment and social participation, affects making friends, and leads to a decrease in medical expenses [ 47 ]. Since agricultural work itself is also a moderate exercise, the possibility of developing lifestyle diseases among the elderly is lower than that among nonfarmers, decreasing medical expenditures [ 19 , 48 , 49 ]. In Brazil, urban agriculture was also suggested to be a tool for health promotion due to its contribution to strengthening individual and community leadership, empowerment, and creating conducive environments for health [ 50 ].…”

“…In Brazil, urban agriculture was also suggested to be a tool for health promotion due to its contribution to strengthening individual and community leadership, empowerment, and creating conducive environments for health [ 50 ]. There was also evidence of negative associations of engaging in agriculture compared with other types of employment with the prevalence of hypertension, being overweight, and obesity, and positive associations with the prevalence of being underweight and smoking [ 48 ].…”

“…However, other issues arise, such as what to do about insurance premiums and the need to revise the system nationwide, where policy revisions must be considered. In addition, MHLW revealed that income disparities affect healthcare and lifestyle-related habits [ 48 ]. Lifestyles were also taken up as a risk factor for health in the health system performance analysis and were one of the critical indicators related to medical expenses, suggesting that it would be more important to improve lifestyles according to income in the future.…”

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“…Socioeconomic status [29] was assessed through economic status (wealth quintile) and social group (marginalised ethnic group: Y/N). Physical activity was accounted for, in part, through the proxy variable of agricultural occupation (Y/N), with agricultural occupation representing higher physical activity [30,31].…”