Abstract
BACKGROUND: The quality of evidence regarding the associations between road traffic noise and hypertension is low due to the limitations of cross-sectional study design, and the role of air pollution remains to be further clarified. OBJECTIVES: The purpose of this study was to evaluate the associations of long-term road traffic noise exposure with incident primary hypertension; we conducted a prospective population-based analysis in UK Biobank. METHODS: Road traffic noise was estimated at baseline residential address using the common noise assessment method model. Incident hypertension was ascertained through linkage with medical records. Cox proportional hazard models were used to estimate hazard ratios (HRs) for association in an analytical sample size of over 240,000 participants free of hypertension at baseline, adjusting for covariates determined via directed acyclic graph. RESULTS: During a median of 8.1 years follow-up, 21,140 incident primary hypertension (International Classification of Diseases-10th Revision [ICD-10]: I10) were ascertained. The HR for a 10 dB[A] increment in mean weighted average 24-hour road traffic noise level (L (den) ) exposure was 1.07 (95% CI: 1.02-1.13). A dose-response relationship was found, with HR of 1.13 (95% CI: 1.03-1.25) for L (den) >65 dB[A] vs ≤55 dB[A] (P for trend <0.05). The associations were all robust to adjustment for fine particles (PM(2.5)) and nitrogen dioxide (NO(2)). Furthermore, high exposure to both road traffic noise and air pollution was associated with the highest hypertension risk. CONCLUSIONS: Long-term exposure to road traffic noise was associated with increased incidence of primary hypertension, and the effect estimates were stronger in presence of higher air pollution.