Environment International (Apr 2025)
Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts
- Huyen Nguyen Thi Khanh,
- Massimo Stafoggia,
- Mette Sørensen,
- Aslak Harbo Poulsen,
- Ole Raaschou-Nielsen,
- Jibran Khan,
- Jørgen Brandt,
- Anja Olsen,
- Zorana Jovanovic Andersen,
- Mette Kildevaeld Simonsen,
- Youn-Hee Lim,
- Jiawei Zhang,
- Thomas Cole-Hunter,
- Göran Pershagen,
- Andrei Pyko,
- Agneta Åkesson,
- Leonard Stockfelt,
- Eva M. Andersson,
- Mikael Ögren,
- David Segersson,
- Annika Rosengren,
- Anna Oudin,
- Maria Albin,
- Gunnar Engström,
- Susanna Gustafsson,
- Kristoffer Mattisson,
- Debora Rizzuto,
- Patrik KE Magnusson,
- Hrafnhildur Gudjonsdottir,
- Karin Leander,
- Timo Lanki,
- Pekka Tiittanen,
- Tarja Yli-Tuomi,
- Pekka Jousilahti,
- Petter Ljungman,
- Jeroen de Bont
Affiliations
- Huyen Nguyen Thi Khanh
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Corresponding author at: Box 210, SE-171 65 Stockholm, SWEDEN.
- Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Italy
- Mette Sørensen
- Danish Cancer Institute, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
- Aslak Harbo Poulsen
- Danish Cancer Institute, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
- Ole Raaschou-Nielsen
- Danish Cancer Institute, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
- Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Anja Olsen
- Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
- Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Mette Kildevaeld Simonsen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Andrei Pyko
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden
- Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Leonard Stockfelt
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Eva M. Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Mikael Ögren
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
- Annika Rosengren
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden; Department of Medicine, Geriatric and Emergency Care, Sahlgrenska University Hospital, Sweden
- Anna Oudin
- Division of Occupational and Environmental Medicine, Lund University, Sweden
- Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Division of Occupational and Environmental Medicine, Lund University, Sweden
- Gunnar Engström
- Division of Occupational and Environmental Medicine, Lund University, Sweden
- Susanna Gustafsson
- Division of Occupational and Environmental Medicine, Lund University, Sweden
- Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Lund University, Sweden
- Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Science and Society, Karolinska Institutet and Stockholm University, Sweden
- Patrik KE Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
- Hrafnhildur Gudjonsdottir
- Department of Global Public Health, Karolinska Institutet, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Timo Lanki
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland; School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
- Pekka Tiittanen
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
- Tarja Yli-Tuomi
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
- Pekka Jousilahti
- Department of Public Health, Finnish Institute for Health and Welfare, Helsinki, Finland
- Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Department of Cardiology, Danderyd University Hospital, Sweden
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
- DOI
- https://doi.org/10.1016/j.envint.2025.109403
- Journal volume & issue
-
Vol. 198
p. 109403
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 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.
Keywords
