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Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts

Thi Khanh, Huyen Nguyen ; Stafoggia, Massimo ; Sørensen, Mette ; Poulsen, Aslak Harbo ; Raaschou-Nielsen, Ole ; Khan, Jibran ; Brandt, Jørgen ; Olsen, Anja ; Andersen, Zorana Jovanovic and Simonsen, Mette Kildevaeld , et al. (2025) In Environment International 198.
Abstract

Introduction: Ambient air pollution and road traffic noise are stroke risk factors, but evidence on their potential joint effects remains limited. This study investigated the independent and joint associations of air pollution and road traffic noise on stroke incidence using both multiplicative and additive scales. Methods: We followed stroke incidence in ten cohorts in Sweden, Denmark, and Finland. We modelled annual average levels of outdoor particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2) and road traffic noise at residential addresses. We applied Cox proportional hazards regression to evaluate their single association. We assessed multiplicative interaction with interaction terms in Cox models and... (More)

Introduction: Ambient air pollution and road traffic noise are stroke risk factors, but evidence on their potential joint effects remains limited. This study investigated the independent and joint associations of air pollution and road traffic noise on stroke incidence using both multiplicative and additive scales. Methods: We followed stroke incidence in ten cohorts in Sweden, Denmark, and Finland. We modelled annual average levels of outdoor particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2) and road traffic noise at residential addresses. We applied Cox proportional hazards regression to evaluate their single association. We assessed multiplicative interaction with interaction terms in Cox models and additive interaction using the Relative Excess Risk due to Interaction method. Results: We followed 136,897 adults for 20 years, and 8.0 % experienced stroke incidence. PM2.5, NO2 and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM2.5 and stroke at higher levels of noise and vice versa: HRs per 5 μg/m3 of PM2.5 were 1.06 (95 % CI:0.94–1.21) at 40 dB and 1.11 (95 % CI:0.85–1.44) at 80 dB of road traffic noise; HRs per 12 dB of road traffic noise were 1.06 (95 % CI:1.01–1.11) at 4 μg/m3 and 1.17 (95 % CI:0.82–1.68) at 48 μg/m3 of PM2.5. Additive models showed that the combined association of PM2.5 and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association. Conclusion: PM2.5 and road traffic noise showed a non-significant synergistic association on stroke incidence.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Additive interaction, Ambient air pollution, Multiplicative interaction, Road traffic noise, Stroke
in
Environment International
volume
198
article number
109403
publisher
Elsevier
external identifiers
  • pmid:40132440
  • scopus:105000461317
ISSN
0160-4120
DOI
10.1016/j.envint.2025.109403
language
English
LU publication?
yes
id
7f10d5b4-cd05-4e4e-a021-07875087161f
date added to LUP
2025-08-19 13:48:07
date last changed
2025-08-20 04:02:35
@article{7f10d5b4-cd05-4e4e-a021-07875087161f,
  abstract     = {{<p>Introduction: Ambient air pollution and road traffic noise are stroke risk factors, but evidence on their potential joint effects remains limited. This study investigated the independent and joint associations of air pollution and road traffic noise on stroke incidence using both multiplicative and additive scales. Methods: We followed stroke incidence in ten cohorts in Sweden, Denmark, and Finland. We modelled annual average levels of outdoor particulate matter &lt; 2.5 µm (PM<sub>2.5</sub>), nitrogen dioxide (NO<sub>2</sub>) and road traffic noise at residential addresses. We applied Cox proportional hazards regression to evaluate their single association. We assessed multiplicative interaction with interaction terms in Cox models and additive interaction using the Relative Excess Risk due to Interaction method. Results: We followed 136,897 adults for 20 years, and 8.0 % experienced stroke incidence. PM<sub>2.5</sub>, NO<sub>2</sub> and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM<sub>2.5</sub> and stroke at higher levels of noise and vice versa: HRs per 5 μg/m<sup>3</sup> of PM<sub>2.5</sub> were 1.06 (95 % CI:0.94–1.21) at 40 dB and 1.11 (95 % CI:0.85–1.44) at 80 dB of road traffic noise; HRs per 12 dB of road traffic noise were 1.06 (95 % CI:1.01–1.11) at 4 μg/m<sup>3</sup> and 1.17 (95 % CI:0.82–1.68) at 48 μg/m<sup>3</sup> of PM<sub>2.5</sub>. Additive models showed that the combined association of PM<sub>2.5</sub> and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association. Conclusion: PM<sub>2.5</sub> and road traffic noise showed a non-significant synergistic association on stroke incidence.</p>}},
  author       = {{Thi Khanh, Huyen Nguyen and Stafoggia, Massimo and Sørensen, Mette and Poulsen, Aslak Harbo and Raaschou-Nielsen, Ole and Khan, Jibran and Brandt, Jørgen and Olsen, Anja and Andersen, Zorana Jovanovic and Simonsen, Mette Kildevaeld and Lim, Youn Hee and Zhang, Jiawei and Cole-Hunter, Thomas and Pershagen, Göran and Pyko, Andrei and Åkesson, Agneta and Stockfelt, Leonard and Andersson, Eva M. and Ögren, Mikael and Segersson, David and Rosengren, Annika and Oudin, Anna and Albin, Maria and Engström, Gunnar and Gustafsson, Susanna and Mattisson, Kristoffer and Rizzuto, Debora and Magnusson, Patrik KE and Gudjonsdottir, Hrafnhildur and Leander, Karin and Lanki, Timo and Tiittanen, Pekka and Yli-Tuomi, Tarja and Jousilahti, Pekka and Ljungman, Petter and de Bont, Jeroen}},
  issn         = {{0160-4120}},
  keywords     = {{Additive interaction; Ambient air pollution; Multiplicative interaction; Road traffic noise; Stroke}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Environment International}},
  title        = {{Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts}},
  url          = {{http://dx.doi.org/10.1016/j.envint.2025.109403}},
  doi          = {{10.1016/j.envint.2025.109403}},
  volume       = {{198}},
  year         = {{2025}},
}