TY - JOUR
T1 - Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts
AU - Thi Khanh, Huyen Nguyen
AU - Stafoggia, Massimo
AU - Sørensen, Mette
AU - Poulsen, Aslak Harbo
AU - Raaschou-Nielsen, Ole
AU - Khan, Jibran
AU - Brandt, Jørgen
AU - Olsen, Anja
AU - Andersen, Zorana Jovanovic
AU - Simonsen, Mette Kildevaeld
AU - Lim, Youn Hee
AU - Zhang, Jiawei
AU - Cole-Hunter, Thomas
AU - Pershagen, Göran
AU - Pyko, Andrei
AU - Åkesson, Agneta
AU - Stockfelt, Leonard
AU - Andersson, Eva M.
AU - Ögren, Mikael
AU - Segersson, David
AU - Rosengren, Annika
AU - Oudin, Anna
AU - Albin, Maria
AU - Engström, Gunnar
AU - Gustafsson, Susanna
AU - Mattisson, Kristoffer
AU - Rizzuto, Debora
AU - Magnusson, Patrik KE
AU - Gudjonsdottir, Hrafnhildur
AU - Leander, Karin
AU - Lanki, Timo
AU - Tiittanen, Pekka
AU - Yli-Tuomi, Tarja
AU - Jousilahti, Pekka
AU - Ljungman, Petter
AU - de Bont, Jeroen
PY - 2025/4
Y1 - 2025/4
N2 - 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.
AB - 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.
KW - Additive interaction
KW - Ambient air pollution
KW - Multiplicative interaction
KW - Road traffic noise
KW - Stroke
KW - Additive interaction
KW - Ambient air pollution
KW - Multiplicative interaction
KW - Road traffic noise
KW - Stroke
U2 - 10.1016/j.envint.2025.109403
DO - 10.1016/j.envint.2025.109403
M3 - Journal article
AN - SCOPUS:105000461317
SN - 0160-4120
VL - 198
JO - Environment International
JF - Environment International
M1 - 109403
ER -