Concomitant exposure to air pollution, green space, and noise and risk of stroke: a cohort study from Denmark

Aslak H Poulsen; Mette Sørensen; Ulla A Hvidtfeldt; Jesper H Christensen; Jørgen Brandt; Lise M Frohn; Matthias Ketzel; Christopher Andersen; Steen Solvang Jensen; Thomas Münzel; Ole Raaschou-Nielsen

doi:10.1016/j.lanepe.2023.100655

Concomitant exposure to air pollution, green space, and noise and risk of stroke: a cohort study from Denmark

Lancet Reg Health Eur. 2023 May 26:31:100655. doi: 10.1016/j.lanepe.2023.100655. eCollection 2023 Aug.

Authors

Aslak H Poulsen¹, Mette Sørensen^{1

2}, Ulla A Hvidtfeldt¹, Jesper H Christensen^{3

4}, Jørgen Brandt^{3

4}, Lise M Frohn^{3

4}, Matthias Ketzel^{3

5}, Christopher Andersen^{3

6}, Steen Solvang Jensen^{3

4}, Thomas Münzel⁷, Ole Raaschou-Nielsen^{1

3}

Affiliations

¹ Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
² Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark.
³ Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.
⁴ iClimate-Interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark.
⁵ Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, University of Surrey, Guildford, UK.
⁶ Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark.
⁷ University Medical Center Mainz of the Johannes Gutenberg University, Center for Cardiology, Cardiology I, Mainz, Germany.

Abstract

Background: Air pollution, road traffic noise, and green space are correlated factors, associated with risk of stroke. We investigated their independent relationship with stroke in multi-exposure analyses and estimated their cumulative stroke burden.

Methods: For all persons, ≥50 years of age and living in Denmark from 2005 to 2017, we established complete address histories and estimated running 5-year mean exposure to fine particles (PM_2.5), ultrafine particles, elemental carbon, nitrogen dioxide (NO₂), and road traffic noise at the most, and least exposed façade. For air pollutants, we estimated total, and non-traffic contributions. Green space around the residence was estimated from land use maps. Hazard ratios (HR) and 95% confidence limits (CL) were estimated with Cox proportional hazards models and used to calculate cumulative risk indices (CRI). We adjusted for the individual and sociodemographic covariates available in our dataset (which did not include information about individual life styles and medical conditions).

Findings: The cohort accumulated 18,344,976 years of follow-up and 94,256 cases of stroke. All exposures were associated with risk of stroke in single pollutant models. In multi-pollutant analyses, only PM_2.5 (HR: 1.058, 95% CI: 1.040-1.075) and noise at most exposed façade (HR: 1.033, 95% CI: 1.024-1.042) were independently associated with a higher risk of stroke. Both noise and air pollution contributed substantially to the CRI (1.103, 95% CI: 1.092-1.114) in the model with noise, green space, and total PM_2.5 concentrations.

Interpretation: Environmental exposure to air pollution and noise were both independently associated with risk of stroke.

Funding: Health Effects Institute (HEI) (Assistance Award No. R-82811201).

Keywords: Air pollution; Green space; Multi-pollutant; Road traffic noise; Stroke.