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

doi:10.1016/j.envint.2025.109403

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 SegerssonAnnika 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

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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 (PM 2.5), nitrogen dioxide (NO 2) 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 2.5, NO 2 and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM 2.5 and stroke at higher levels of noise and vice versa: HRs per 5 μg/m 3 of PM 2.5 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/m 3 and 1.17 (95 % CI:0.82-1.68) at 48 μg/m 3 of PM 2.5. Additive models showed that the combined association of PM 2.5 and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association.

CONCLUSION: PM 2.5 and road traffic noise showed a non-significant synergistic association on stroke incidence.

Originalsprog	Engelsk
Artikelnummer	109403
Tidsskrift	Environment International
Vol/bind	198
Antal sider	11
ISSN	0160-4120
DOI	https://doi.org/10.1016/j.envint.2025.109403
Status	Udgivet - 2025

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10.1016/j.envint.2025.109403Licens: CC BY

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Thi Khanh, H. N., Stafoggia, M., Sørensen, M., Poulsen, A. H., Raaschou-Nielsen, O., Khan, J., Brandt, J., Olsen, A., Andersen, Z. J., Simonsen, M. K., Lim, Y.-H., Zhang, J., Cole-Hunter, T., Pershagen, G., Pyko, A., Åkesson, A., Stockfelt, L., Andersson, E. M., Ögren, M., ... de Bont, J. (2025). Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts. Environment International, 198, Artikel 109403. https://doi.org/10.1016/j.envint.2025.109403

Thi Khanh, HN, Stafoggia, M, Sørensen, M, Poulsen, AH, Raaschou-Nielsen, O, Khan, J, Brandt, J, Olsen, A, Andersen, ZJ, Simonsen, MK, Lim, Y-H , Zhang, J , Cole-Hunter, T, Pershagen, G, Pyko, A, Åkesson, A, Stockfelt, L, Andersson, EM, Ögren, M, Segersson, D, Rosengren, A, Oudin, A, Albin, M, Engström, G, Gustafsson, S, Mattisson, K, Rizzuto, D, Magnusson, PK, Gudjonsdottir, H, Leander, K, Lanki, T, Tiittanen, P, Yli-Tuomi, T, Jousilahti, P, Ljungman, P & de Bont, J 2025, 'Exploring the interaction between ambient air pollution and road traffic noise on stroke incidence in ten Nordic cohorts', Environment International, bind 198, 109403. https://doi.org/10.1016/j.envint.2025.109403

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

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 (PM 2.5), nitrogen dioxide (NO 2) 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 2.5, NO 2 and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM 2.5 and stroke at higher levels of noise and vice versa: HRs per 5 μg/m 3 of PM 2.5 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/m 3 and 1.17 (95 % CI:0.82-1.68) at 48 μg/m 3 of PM 2.5. Additive models showed that the combined association of PM 2.5 and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association. CONCLUSION: PM 2.5 and road traffic noise showed a non-significant synergistic association on stroke incidence. ",

author = "{Thi Khanh}, {Huyen Nguyen} and Massimo Stafoggia and Mette S{\o}rensen and Poulsen, {Aslak Harbo} and Ole Raaschou-Nielsen and Jibran Khan and J{\o}rgen Brandt and Anja Olsen and Andersen, {Zorana Jovanovic} and Simonsen, {Mette Kildevaeld} and Youn-Hee Lim and Jiawei Zhang and Thomas Cole-Hunter and G{\"o}ran Pershagen and Andrei Pyko and Agneta {\AA}kesson and Leonard Stockfelt and Andersson, {Eva M} and Mikael {\"O}gren and David Segersson and Annika Rosengren and Anna Oudin and Maria Albin and Gunnar Engstr{\"o}m and Susanna Gustafsson and Kristoffer Mattisson and Debora Rizzuto and Magnusson, {Patrik Ke} and Hrafnhildur Gudjonsdottir and Karin Leander and Timo Lanki and Pekka Tiittanen and Tarja Yli-Tuomi and Pekka Jousilahti and Petter Ljungman and {de Bont}, Jeroen",

year = "2025",

doi = "10.1016/j.envint.2025.109403",

language = "English",

volume = "198",

journal = "Environment International",

issn = "0160-4120",

publisher = "Pergamon Press",

}

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

Y1 - 2025

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 (PM 2.5), nitrogen dioxide (NO 2) 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 2.5, NO 2 and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM 2.5 and stroke at higher levels of noise and vice versa: HRs per 5 μg/m 3 of PM 2.5 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/m 3 and 1.17 (95 % CI:0.82-1.68) at 48 μg/m 3 of PM 2.5. Additive models showed that the combined association of PM 2.5 and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association. CONCLUSION: PM 2.5 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 (PM 2.5), nitrogen dioxide (NO 2) 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 2.5, NO 2 and road traffic noise were associated with higher stroke risk in single-exposure models. Multiplicative models showed higher HRs between PM 2.5 and stroke at higher levels of noise and vice versa: HRs per 5 μg/m 3 of PM 2.5 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/m 3 and 1.17 (95 % CI:0.82-1.68) at 48 μg/m 3 of PM 2.5. Additive models showed that the combined association of PM 2.5 and road traffic noise was 4 % (RERI = 0.04 (95 % CI:-0.05;1.12)) higher than the sum of their individual association. CONCLUSION: PM 2.5 and road traffic noise showed a non-significant synergistic association on stroke incidence.

U2 - 10.1016/j.envint.2025.109403

DO - 10.1016/j.envint.2025.109403

M3 - Journal article

C2 - 40132440

SN - 0160-4120

VL - 198

JO - Environment International

JF - Environment International

M1 - 109403

ER -