Table 2. Associations between food biodiversity and cause-specific mortality rates from multivariable Cox proportional hazards regression models, EPIC cohort, 1992 to 2014.
| Qs of DSR | ||||||||
|---|---|---|---|---|---|---|---|---|
| Per 10-species increment | P-valuec | Q1 | Q2 | Q3 | Q4 | Q5 | P-trendc | |
| DSR, species per year | <48 | [48 to 64] | [64 to 72] | [72 to 81] | ≥81 | |||
| Cancer | ||||||||
| All (cases/person-years) | 19,284/7,506,482 | 4,335/1,577,991 | 4,385/1,662,237 | 3,621/1,532,349 | 3,860/1,479,202 | 3,083/1,254,703 | ||
| Sex-adjusted model—HR (95% CI)a | 0.89 (0.88 to 0.91) | <0.001 | 1.00 (ref) | 0.87 (0.82 to 0.91) | 0.77 (0.72 to 0.82) | 0.67 (0.62 to 0.71) | 0.64 (0.59 to 0.69) | <0.001 |
| Multiadjusted model—HR (95% CI)b | 0.93 (0.92 to 0.95) | <0.001 | 1.00 (ref) | 0.92 (0.87 to 0.97) | 0.87 (0.82 to 0.93) | 0.78 (0.73 to 0.83) | 0.75 (0.69 to 0.82) | <0.001 |
| CVD | ||||||||
| All (cases/person-years) | 6,403/7,506,482 | 1,477/1,577,991 | 1,526/1,662,237 | 1,077/1,532,349 | 1,148/1,532,349 | 1,175/1,254,703 | ||
| Sex-adjusted model—HR (95% CI)a | 0.82 (0.80 to 0.84) | <0.001 | 1.00 (ref) | 0.84 (0.77 to 0.92) | 0.63 (0.56 to 0.70) | 0.51 (0.45 to 0.58) | 0.44 (0.38 to 0.50) | <0.001 |
| Multiadjusted model—HR (95% CI)b | 0.88 (0.85 to 0.91) | <0.001 | 1.00 (ref) | 0.94 (0.86 to 1.03) | 0.78 (0.69 to 0.87) | 0.65 (0.57 to 0.74) | 0.56 (0.49 to 0.65) | <0.001 |
| CHD | ||||||||
| All (cases/person-years) | 4,950/7,506,482 | 1,195/1,577,991 | 1,081/1,662,237 | 679/1,532,349 | 873/1,532,349 | 1,122/1,254,703 | ||
| Sex-adjusted model—HR (95% CI)a | 0.77 (0.74 to 0.79) | <0.001 | 1.00 (ref) | 0.72 (0.65 to 0.80) | 0.52 (0.45 to 0.60) | 0.46 (0.39 to 0.53) | 0.35 (0.30 to 0.42) | <0.001 |
| Multiadjusted model—HR (95% CI)b | 0.87 (0.84 to 0.90) | <0.001 | 1.00 (ref) | 0.89 (0.80 to 0.99) | 0.75 (0.64 to 0.86) | 0.67 (0.58 to 0.78) | 0.55 (0.46 to 0.65) | <0.001 |
| Respiratory disease | ||||||||
| All (cases/person-years) | 2,479/7,506,482 | 500/1,577,991 | 560/1,662,237 | 459/1,532,349 | 481/1,479,202 | 479/1,254,703 | ||
| Sex-adjusted model—HR (95% CI)a | 0.73 (0.70 to 0.76) | <0.001 | 1.00 (ref) | 0.74 (0.64 to 0.86) | 0.50 (0.41 to 0.60) | 0.35 (0.29 to 0.42) | 0.27 (0.21 to 0.34) | <0.001 |
| Multiadjusted model—HR (95% CI)b | 0.84 (0.80 to 0.88) | <0.001 | 1.00 (ref) | 0.93 (0.80 to 1.09) | 0.75 (0.62 to 0.91) | 0.56 (0.46 to 0.69) | 0.44 (0.34 to 0.55) | <0.001 |
| Digestive disease | ||||||||
| All (cases/person-years) | 1,386/7,506,482 | 278/1,577,991 | 331/1,662,237 | 227/1,532,349 | 269/1,479,202 | 281/1,254,703 | ||
| Sex-adjusted model—HR (95% CI)a | 0.73 (0.69 to 0.77) | <0.001 | 1.00 (ref) | 0.82 (0.67 to 1.01) | 0.45 (0.35 to 0.58) | 0.36 (0.28 to 0.47) | 0.32 (0.23 to 0.42) | <0.001 |
| Multiadjusted model—HR (95% CI)b | 0.80 (0.76 to 0.86) | <0.001 | 1.00 (ref) | 0.98 (0.80 to 1.21) | 0.64 (0.49 to 0.83) | 0.53 (0.41 to 0.69) | 0.46 (0.34 to 0.63) | <0.001 |
aSex-adjusted models were stratified for center, age at recruitment (1-year intervals, timescale), and sex.
bMultiadjusted models were stratified for center, age at recruitment (1-year intervals, timescale), and sex and adjusted for baseline alcohol intake (g/day), physical activity (Cambridge index: active; moderately active; moderately inactive; inactive; missing), marital status (single, divorced, separated, or widowed; married or living together; unknown), smoking status and intensity of smoking (current, 1 to 15 cigarettes/day; current, 16 to 25 cigarettes/day; current, 26+ cigarettes/day; current, pipe/cigar/occasional; current/former, missing; former, quit 11 to 20 years; former, quit 20+ years; former, quit ≤10 years; never; unknown), educational level [longer education (including university degree, technical or professional school); secondary school; primary school completed; not specified], baseline energy intake (kcal/day), baseline fiber intake (g/day), baseline red and processed meat consumption (g/day), and an 18-point Mediterranean diet score [49].
cP-values remained statistically significant after adjustment for multiple testing using the Benjamini–Hochberg method.
CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; DSR, dietary species richness; EPIC, European Prospective Investigation into Cancer and Nutrition; HR, hazard ratio.