Associations between residential exposure to aircraft noise, cardiovascular disease, and all-cause mortality in the Nurses’ Health Studies

BACKGROUND AND AIM: Aircraft noise is hypothesized to increase cardiovascular disease (CVD) risk and mortality through multiple pathways; however, there is limited evidence. We aim to examine associations between aircraft noise, CVD, and all-cause mortality in the prospective US-based Nurses’ Health Studies (NHS/NHSII). METHODS: Between 1994 and 2014, we followed 109,432 participants from NHS and 114,746 from NHSII free of CVD at baseline. Aircraft noise was estimated for 90 US airports in 5-year intervals and linked to geocoded residential addresses. Time-varying Cox proportional hazards models were used to assess relationships between dichotomized (< vs. ≥45 dB(A)) day-night average sound level (DNL) and each outcome, adjusting for race/ethnicity, spouse’s education, region, fine particulate matter (PM2.5), neighborhood socioeconomic status (nSES), population density, lifestyle factors, menopausal status, and family history of CVD. We assessed effect modification by duration at current residence, nSES, PM2.5, and population density. RESULTS: Over 20 years of follow-up, there were 8,730 CVD cases and 28,312 deaths in NHS as well as 1,482 CVD cases and 2,471 deaths in NHSII. Approximately 7% of participants were exposed to DNL ≥45 dB(A). In CVD models, we observed adjusted hazard ratios (aHRs) of 0.95 (95% CI: 0.88, 1.04) in NHS and 0.99 (95% CI: 0.81, 1.21) in NHSII comparing exposed and unexposed participants. Similarly, for all-cause mortality, we observed aHRs of 0.99 (95% CI: 0.94, 1.03) and 1.00 (95% CI: 0.86, 1.16) in NHS and NHSII, respectively. We only observed evidence of effect modification by nSES on noise and all-cause mortality in NHS, with greater adverse effects of noise among those living in areas of higher nSES. CONCLUSIONS: We did not find associations between noise and CVD or all-cause mortality overall. Unexpectedly, we found associations between aviation noise and all-cause mortality among those living in more affluent areas. KEYWORDS: aircraft, noise, CVD