Association Between Road Traffic Noise and Incidence of Diabetes Mellitus and Hypertension in Toronto, Canada: A Population-Based Cohort Study

Pathomechanistic synergy between particulate matter and traffic noise induced cardiovascular damage and the classical risk factor hypertension

SIGNIFICANCE

In all modern urbanized and industrialized societies, non-communicable diseases, like cardiovascular disease (CVD), are becoming a more important cause of morbidity and mortality. Classic risk factors for CVDs, such as hypertension, are reinforced by behavioral risk factors, like smoking and diet, and environmental risk factors, like transportation noise and air pollution.

RECENT ADVANCES

Both transportation noise and air pollution have individually been shown to increase the risk for CVD in large cohorts. Insights from animal studies have revealed pathophysiologic mechanisms by which these stressors influence the cardiovascular system. Noise primarily causes annoyance and sleep disturbance, promoting the release of stress hormones. Air pollution primarily damages the lung, where it causes local inflammation and an increase in oxidative stress, which can propagate to the circulation and remote organs.

CRITICAL ISSUES

Both noise and air pollution converge at the vascular level, where the inflammatory state and oxidative stress cause dysfunction in vascular signaling and promote atherosclerotic plaque formation and thrombosis. Both inflammation and oxidative stress are key aspects of traditional cardiovascular risk factors, such as arterial hypertension. The similarities among the mechanisms of environmental risk factor-induced CVD and hypertension indicate that a complex interplay between them can drive the onset and progression of CVDs, leading to synergistic health impacts.

FUTURE DIRECTIONS

Our present overview of the negative effects of noise and air pollution on the cardiovascular system provides a mechanistic link to the traditional CVD risk factor, hypertension, which could be used to protect patients with pre-existing CVD better.

Long-term exposure to transportation noise and diabetes mellitus mortality: a national cohort study and updated meta-analysis

BACKGROUND

Long-term exposure to transportation noise is related to cardio-metabolic diseases, with more recent evidence also showing associations with diabetes mellitus (DM) incidence. This study aimed to evaluate the association between transportation noise and DM mortality within the Swiss National Cohort.

METHODS

During 15 years of follow-up (2001-2015; 4.14 million adults), over 72,000 DM deaths were accrued. Source-specific noise was calculated at residential locations, considering moving history. Multi-exposure, time-varying Cox regression was used to derive hazard ratios (HR, and 95%-confidence intervals). Models included road traffic, railway and aircraft noise, air pollution, and individual and area-level covariates including socio-economic position. Analyses included exposure-response modelling, effect modification, and a subset analysis around airports. The main findings were integrated into meta-analyses with published studies on mortality and incidence (separately and combined).

RESULTS

HRs were 1.06 (1.05, 1.07), 1.02 (1.01, 1.03) and 1.01 (0.99, 1.02) per 10 dB day evening-night level (Lden) road traffic, railway and aircraft noise, respectively (adjusted model, including NO2). Splines suggested a threshold for road traffic noise (~ 46 dB Lden, well below the 53 dB Lden WHO guideline level), but not railway noise. Substituting for PM2.5, or including deaths with type 1 DM hardly changed the associations. HRs were higher for males compared to females, and in younger compared to older adults. Focusing only on type 1 DM showed an independent association with road traffic noise. Meta-analysis was only possible for road traffic noise in relation to mortality (1.08 [0.99, 1.18] per 10 dB, n = 4), with the point estimate broadly similar to that for incidence (1.07 [1.05, 1.09] per 10 dB, n = 10). Combining incidence and mortality studies indicated positive associations for each source, strongest for road traffic noise (1.07 [1.05, 1.08], 1.02 [1.01, 1.03], and 1.02 [1.00, 1.03] per 10 dB road traffic [n = 14], railway [n = 5] and aircraft noise [n = 5], respectively).

CONCLUSIONS

This study provides new evidence that transportation noise is associated with diabetes mortality. With the growing evidence and large disease burden, DM should be viewed as an important outcome in the noise and health discussion.

Transportation Noise Pollution and Cardiovascular Health

Epidemiological studies have found that transportation noise increases the risk for cardiovascular morbidity and mortality, with solid evidence for ischemic heart disease, heart failure, and stroke. According to the World Health Organization, at least 1.6 million healthy life years are lost annually from traffic-related noise in Western Europe. Traffic noise at night causes fragmentation and shortening of sleep, elevation of stress hormone levels, and increased oxidative stress in the vasculature and the brain. These factors can promote vascular (endothelial) dysfunction, inflammation, and arterial hypertension, thus elevating cardiovascular risk. The present review focusses on the indirect, nonauditory cardiovascular health effects of noise. We provide an updated overview of epidemiological research on the effects of transportation noise on cardiovascular risk factors and disease, and mechanistic insights based on the latest clinical and experimental studies and propose new risk markers to address noise-induced cardiovascular effects in the general population. We will discuss the potential effects of noise on vascular dysfunction, oxidative stress, and inflammation in humans and animals. We will elaborately explain the underlying pathomechanisms by alterations of gene networks, epigenetic pathways, circadian rhythm, signal transduction along the neuronal-cardiovascular axis, and metabolism. We will describe current and future noise mitigation strategies. Finally, we will conduct an overall evaluation of the status of the current evidence of noise as a significant cardiovascular risk factor.

Air pollution, traffic noise, greenness, and temperature and the risk of incident type 2 diabetes: Results from the KORA cohort study

Introduction

Type 2 diabetes (T2D) is a major public health concern, and various environmental factors have been associated with the development of this disease. This study aimed to investigate the longitudinal effects of multiple environmental exposures on the risk of incident T2D in a German population-based cohort.

Methods

We used data from the KORA cohort study (Augsburg, Germany) and assessed exposure to air pollutants, traffic noise, greenness, and temperature at the participants' residencies. Cox proportional hazard models were used to analyze the associations with incident T2D, adjusting for potential confounders.

Results

Of 7736 participants included in the analyses, 10.5% developed T2D during follow-up (mean: 15.0 years). We found weak or no association between environmental factors and the risk of T2D, with sex and education level significantly modifying the effects of air pollutants.

Conclusion

Our study contributes to the growing body of literature investigating the impact of environmental factors on T2D risks and suggests that the impact of environmental factors may be small.

Statistical estimation of noise induced hearing loss among the drivers in one of the most polluted cities of India

In the present study, an attempt has been made to assess the impact of vehicular noise upon the 3-wheeler tempo drivers and to know whether there is any relationship between hearing loss and cumulative noise exposure. For this purpose, 3-wheeler tempo drivers (Exposed group) and non-commercial light motor vehicle car drivers (Unexposed group) were chosen as study subjects. Three traffic routes were selected to assess the noise level during waiting and running time in the exposed and unexposed groups. Among all three routes, the highest mean noise level (Leq) was observed on the Chowk to Dubagga route for waiting and en-route noise measurement. It was measured as 84.13 dB(A) and 86.36 dB(A) for waiting and en-route periods of 7.68 ± 3.46 and 31.05 ± 6.6 min, respectively. Cumulative noise exposure was found to be significantly different (p < 0.001) in all age groups of exposed and unexposed drivers. Audiometric tests have been performed over both exposed and unexposed groups. The regression analysis has been done keeping hearing loss among tempo drivers as the dependent variable and age (years) and Energy (Pa2 Hrs) as the independent variable using three different criteria of hearing loss definitions, i.e., World Health Organization, National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration criteria. Among these three criteria, the NIOSH criterion of hearing loss best explained the independent variables. It could explain the total variation in dependent variable by independent variable quite well, i.e., 68.1%. The finding showed a linear relationship between cumulative noise exposures (Pa2 Hrs) and the exposed group's hearing loss (dB), i.e., hearing loss increases with increasing noise dose. Based on the findings, two model equations were developed to identify the safe and unsafe noise levels with exposure time.

Exposure to residential traffic and trajectories of unhealthy ageing: results from a nationally-representative cohort of older adults

BACKGROUND

Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown.

METHODS

Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces.

RESULTS

At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities.

CONCLUSIONS

Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age.

Health position paper and redox perspectives - Disease burden by transportation noise

Transportation noise is a ubiquitous urban exposure. In 2018, the World Health Organization concluded that chronic exposure to road traffic noise is a risk factor for ischemic heart disease. In contrast, they concluded that the quality of evidence for a link to other diseases was very low to moderate. Since then, several studies on the impact of noise on various diseases have been published. Also, studies investigating the mechanistic pathways underlying noise-induced health effects are emerging. We review the current evidence regarding effects of noise on health and the related disease-mechanisms. Several high-quality cohort studies consistently found road traffic noise to be associated with a higher risk of ischemic heart disease, heart failure, diabetes, and all-cause mortality. Furthermore, recent studies have indicated that road traffic and railway noise may increase the risk of diseases not commonly investigated in an environmental noise context, including breast cancer, dementia, and tinnitus. The harmful effects of noise are related to activation of a physiological stress response and nighttime sleep disturbance. Oxidative stress and inflammation downstream of stress hormone signaling and dysregulated circadian rhythms are identified as major disease-relevant pathomechanistic drivers. We discuss the role of reactive oxygen species and present results from antioxidant interventions. Lastly, we provide an overview of oxidative stress markers and adverse redox processes reported for noise-exposed animals and humans. This position paper summarizes all available epidemiological, clinical, and preclinical evidence of transportation noise as an important environmental risk factor for public health and discusses its implications on the population level.

Long-term NO2 exposure and mortality: A comprehensive meta-analysis

In response to the World Health Organization's (WHO) revised annual mean nitrogen dioxide (NO2) standard from 40 μg/m3 to 10 μg/m3, reflecting the growing evidence linking long-term exposure to ambient NO2 and excess mortality, we conducted a comprehensive meta-analysis incorporating 11 new studies published since the WHO analysis. Our investigation involved a systematic search of three major databases (PubMed, Web of Science, and Scopus) for articles published until July 1, 2022. We employed random effects models to calculate summarized risk ratios (RR) along with 95% confidence intervals (CIs) for overall and subgroup analyses. Sensitivity analyses were conducted to assess result robustness, and publication bias was evaluated using funnel plots and Egger's linear regression. Out of 2799 identified articles, 56 were included in our meta-analysis. The findings indicate a heightened risk of all-cause, cardiovascular, and respiratory mortality associated with long-term exposure to ambient NO2, with pooled RR values of 1.03 (95% CI: 1.02, 1.05), 1.07 (95% CI: 1.04, 1.10), and 1.03 (95% CI: 1.02, 1.05) per 10 μg/m3 increase, respectively. Substantial heterogeneity (I2 = 84%-96%) among studies was observed. Subgroup analysis revealed significantly elevated RR values in Asia and Oceania (p-value <0.05). The aggregated values for all-cause and cardiovascular mortality were slightly larger than those reported in previous studies. Our study emphasizes the imperative to develop more patient cohorts and conduct age-refined analyses to explore the impact of existing chronic diseases on these associations. Further, additional cohorts in Asia and Oceania are essential to fortify evidence in these regions. Lastly, we recommend using fused multi-source data with higher spatiotemporal resolution for individual exposure representation to minimize heterogeneity among studies in future research.

Effect of chronic noise exposure on glucose and lipid metabolism in mice via modulating gut microbiota and regulating CREB/CRTC2 and SREBP1/SCD pathway

Chronic noise exposure is correlated with gut microbiota dysbiosis and glucose and lipid metabolism disorders. However, evidence on the mechanisms underlying of gut microbiota alterations in chronic noise induced glucose and lipid metabolism disorders is limited, and the potential aftereffects of chronic noise exposure on metabolic disorders remain unclear. In present study, we established chronic daytime and nighttime noise exposure mice models to explore the effects and underlying mechanism of gut microbiota on chronic noise-induced glucose and lipid metabolism disorders. The results showed that exposure to chronic daytime or nighttime noise significantly increased the fasting blood glucose, serum and liver TG levels, impaired glucose tolerance, and decreased serum HDL-C levels and liver TC levels in mice. However, after 4 weeks of recovery, only serum TG of mice in nighttime noise recovery group remained elevated. Besides, exposure to chronic noise reduced the intestinal tight junction protein levels and increased intestinal permeability, while this effect did not completely dissipate even after the recovery period. Moreover, chronic noise exposure changed the gut microbiota and significantly regulated metabolites and metabolic pathways, and further activate hepatic gluconeogenesis CRTC2/CREB-PCK1 signaling pathway and lipid synthesis SREBP1/SCD signaling pathway through intestinal hepatic axis. Together, our findings demonstrated that chronic daytime and nighttime noise exposure could cause the glucose and lipid metabolism disorder by modulating the gut microbiota and serum metabolites, and activating hepatic gluconeogenic CREB/CRTC2-PCK1 signaling and lipid synthesis SREBP1/SCD signaling pathway. The potential aftereffects of noise exposure during wakefulness on metabolic disorders are more significant than that of noise exposure during sleep.

Physiological Effects of Co-exposure to Ionizing Radiation and Noise within Occupational Exposure Limits

ABSTRACT

Workers are frequently exposed to the occupational hazards of ionizing radiation and noise. Co-exposure to these hazards is not well understood in terms of their physiological effects. The aim of this study was to investigate the physiological effects of co-exposure to ionizing radiation and noise within the occupational limit. This study extracted the physical examination parameters of workers who met the screening criteria from the occupational health surveillance database. The workers were divided into three groups: the co-exposure (COE) group, the ionizing radiation exposure (ION) group, and the non-exposure (NON) group. The age and sex of the three groups were matched with a sample size ratio of 1:3:3. The physical examination parameters of the three groups of workers were compared. The results showed that there was no significant difference in blood pressure and blood biochemical parameters among the three groups. The COE group had higher levels of free triiodothyronine than the ION group, but there was no difference with the NON group. Moreover, the COE group had lower levels of free tetraiodothyronine than the ION group and the NON group. There was no significant difference in thyroid stimulating hormone, total triiodothyronine, and total tetraiodothyronine among the three groups. Additionally, the number of white blood cells of the COE group was lower than that of ION group and NON group. This study suggests that co-exposure to low-dose ionizing radiation and noise can cause alterations in thyroid hormone and peripheral white blood cells. These alterations are different from those observed after single exposure to low-dose ionizing radiation and require further research.

Aircraft and road traffic noise, insulin resistance, and diabetes: The role of neighborhood socioeconomic status in San Diego County

Evidence linking traffic noise to insulin resistance and diabetes is limited and unanswered questions remain regarding the potential effect modification by neighborhood socioeconomic status (nSES). We aimed to assess socioeconomic inequalities in noise exposure, whether road and aircraft noise exposures were associated with insulin resistance or diabetes, and whether nSES modified these relationships. Among the Community of Mine Study in San Diego County, road and aircraft noise exposure at enrollment was calculated based on the static (participant's administrative boundary, and circular buffer around participant homes), and dynamic (mobility data by global positioning system, GPS) spatio-temporal aggregation methods. Associations of noise with insulin resistance (HOMA-IR) or type 2 diabetes (T2DM) were quantified using generalized estimating equation models adjusted for sex, age, ethnicity, individual income, and air pollution (nitrogen dioxide) exposure. Additive interaction between noise and nSES was assessed. Among 573 participants (mean age 58.7 y), participants living in low nSES were exposed to higher levels of aircraft and road noise using noise level at the census tract, circular buffer, or Kernel Density Estimation (KDE) of GPS data. Participants exposed to road noise greater or equal to the median (53 dB(A)) at the census tract and living in low nSES had an increased level of insulin resistance (β = 0.15, 95%CI: -0.04, 0.34) and higher odds of T2DM (Odds Ratio = 2.34, 95%CI: 1.12, 4.90). A positive additive interaction was found as participants living in low nSES had higher odds of T2DM. The impact of noise exposure on insulin resistance and T2DM differs substantially by nSES. Public health benefits of reducing exposure to road or aircraft noise would be larger in individuals living in low nSES.

Development of multi-scale indices of human mobility restriction during the COVID-19 based on air quality from local and global NO2 concentration

This study investigated whether variability in air quality, especially related to vehicular emissions, during the COVID-19 pandemic could indicate social distancing. Data from in situ measurements and satellite estimates were used. The study areas were São Paulo, Brazil, and Bologna, Italy. We focused our analysis on NO2, a combustion-derived pollutant, because of its availability in surface stations and satellite tracking, and because it has a short atmospheric lifetime. The analyses included graphical, statistical, and wavelet transform-based approaches to understand NO2 concentrations before and during the pandemic. After confirming the reduction in vehicular emissions during the pandemic, we created normalized indices to assess the social remoteness in 2020 in different locations, with a focus on São Paulo and Bologna. These indices were compared to existing indices based on cell phone mobility. The indices proposed in this study suffered high sensitivity to social distance compared to existing ones and helped to understand the actual application of social distance and contamination rates, considering the various dimensions of the problem.

Does air pollution confound associations between environmental noise and cardiovascular outcomes? - A systematic review

BACKGROUND

Exposure to environmental noise is associated with adverse health effects, but there is potential for confounding and interaction with air pollution, particularly where both exposures arise from the same source, such as transport.

OBJECTIVES

To review evidence on confounding and interaction of air pollution in relation to associations between environmental noise and cardiovascular outcomes.

METHODS

Papers were identified from similar reviews published in 2013 and 2015, from the systematic reviews supporting the WHO 2018 noise guidelines, and from a literature search covering the period 2016-2022 using Medline and PubMed databases. Additional papers were identified from colleagues. Study selection was according to PECO inclusion criteria. Studies were evaluated against the WHO checklist for risk of bias.

RESULTS

52 publications, 36 published after 2015, were identified that assessed associations between transportation noise and cardiovascular outcomes, that also considered potential confounding (49 studies) or interaction (23 studies) by air pollution. Most, but not all studies, suggested that the associations between traffic noise and cardiovascular outcomes are independent of air pollution. NO2 or PM2.5 were the most commonly included air pollutants and we observed no clear differences across air pollutants in terms of the potential confounding role. Most papers did not appear to suggest an interaction between noise and air pollution. Eight studies found the largest noise effect estimates occurring within the higher noise and air pollution exposure categories, but were not often statistically significant.

CONCLUSION

Whilst air pollution does not appear to confound associations of noise and cardiovascular health, more studies on potential interactions are needed. Current methods to assess quality of evidence are not optimal when evaluating evidence on confounding or interaction.

Impact of Environmental Factors on Hypertension and Associated Cardiovascular Disease

Hypertension is the primary cause of cardiovascular diseases and is responsible for nearly 9 million deaths worldwide annually. Increasing evidence indicates that in addition to pathophysiologic processes, numerous environmental factors, such as geographic location, lifestyle choices, socioeconomic status, and cultural practices, influence the risk, progression, and severity of hypertension, even in the absence of genetic risk factors. In this review, we discuss the impact of some environmental determinants on hypertension. We focus on clinical data from large population studies and discuss some potential molecular and cellular mechanisms. We highlight how these environmental determinants are interconnected, as small changes in one factor might affect others, and further affect cardiovascular health. In addition, we discuss the crucial impact of socioeconomic factors and how these determinants influence diverse communities with economic disparities. Finally, we address opportunities and challenges for new research to address gaps in knowledge on understanding molecular mechanisms whereby environmental factors influence development of hypertension and associated cardiovascular disease.

Associations of bedroom PM2.5, CO2, temperature, humidity, and noise with sleep: An observational actigraphy study

OBJECTIVE

Climate change and urbanization increasingly cause extreme conditions hazardous to health. The bedroom environment plays a key role for high-quality sleep. Studies objectively assessing multiple descriptors of the bedroom environment as well as sleep are scarce.

METHODS

Particulate matter with a particle size <2.5 µm (PM2.5), temperature, humidity, carbon dioxide (CO2), barometric pressure, and noise levels were continuously measured for 14 consecutive days in the bedroom of 62 participants (62.9% female, mean ± SD age: 47.7 ± 13.2 years) who wore a wrist actigraph and completed daily morning surveys and sleep logs.

RESULTS

In a hierarchical mixed effect model that included all environmental variables and adjusted for elapsed sleep time and multiple demographic and behavioral variables, sleep efficiency calculated for consecutive 1-hour periods decreased in a dose-dependent manner with increasing levels of PM2.5, temperature, CO2, and noise. Sleep efficiency in the highest exposure quintiles was 3.2% (PM2.5, p < .05), 3.4% (temperature, p < .05), 4.0% (CO2, p < .01), and 4.7% (noise, p < .0001) lower compared to the lowest exposure quintiles (all p-values adjusted for multiple testing). Barometric pressure and humidity were not associated with sleep efficiency. Bedroom humidity was associated with subjectively assessed sleepiness and poor sleep quality (both p < .05), but otherwise environmental variables were not statistically significantly associated with actigraphically assessed total sleep time and wake after sleep onset or with subjectively assessed sleep onset latency, sleep quality, and sleepiness. Assessments of bedroom comfort suggest subjective habituation irrespective of exposure levels.

CONCLUSIONS

These findings add to a growing body of evidence highlighting the importance of the bedroom environment-beyond the mattress-for high-quality sleep.

Associations between environmental noise and myocardial infarction and stroke: Investigating the potential mediating effects of hypertension

BACKGROUND

We investigated whether hypertension may be a mediator in the pathway linking environmental noise exposure to incident MI and stroke.

METHODS

Separately for MI and stroke, we built two population-based cohorts from linked health administrative data. Participants were residents of Montreal (Canada) between 2000 and 2014, aged 45 years and older who were free of hypertension and MI or stroke at time of entry. MI, stroke and hypertension were ascertained from validated case definitions. Residential long-term environmental noise exposure, expressed as the annual mean level acoustic equivalent 24 h (L_Aeq24h), was estimated from a land use regression model. We performed mediation analysis based on the potential outcomes framework. We used a Cox proportional hazards model for the exposure-outcome model and a logistic regression for the exposure-mediator model. In sensitivity analysis we applied a marginal structural approach to estimate the natural direct and indirect effects.

RESULTS

Each cohort included approximately 900 000 individuals, with 26 647 incident cases of MI and 16 656 incident cases of stroke. 36% of incident MI and 40% of incident stokes had previously developed hypertension. The estimated total effect per interquartile range increase (from 55.0 to 60.5 dB A) in the annual mean L_Aeq24h was 1.073 (95% confidence interval (CI): 1.070-1.077) for both MI for stroke. We found no evidence of exposure-mediator interaction for both outcomes. The relationships between environmental noise and MI and stroke was not mediated by hypertension.

CONCLUSIONS

This population-based cohort study suggests that the main route by which environmental noise exposure may cause MI or stroke is not through hypertension.

The association between road traffic noise and type 2 diabetes: a systematic review and meta-analysis of cohort studies

The association between road traffic noise and type 2 diabetes (T2DM) was inconsistent. To address this, we have synthesized available cohort studies about their association by meta-analysis. PubMed, Web of Science, EBSCO, Cochrane Library, EMBASE, and Scopus databases were searched up to July 2022. The Quality-effect model (QE) was used to incorporate the results of included studies. The possibility of publication bias was assessed by the Doi plots and Luis Furuya-Kanamori index. Sensitivity analyses included leave-one-out meta-analysis, subgroup meta-analysis, and meta-regressions. The Recommendations for Assessment, Development, and Evaluation (GRADE) guidelines were conducted to evaluate the overall quality of evidence. Eight cohort studies with 4,989,846 participants and 416,799 diabetes cases were included. Based on the fully adjusted models from 8 cohort studies (10 estimates; Lden range ≈ 15-98.5 dB(A)), we found "high" evidence of RR per 10 dB(A) = 1.07 (1.05, 1.10), high heterogeneity (I2 = 0.91%, p < 0.001), and high publication bias (LKF index = 4.55). Sensitivity analyses showed stable model results, and the GRADE assessment suggested the current overall quality of evidence is high. Comprehensive evidence from cohort studies supports that increasing exposure to road traffic noise may be associated with higher risk of T2DM.

Dose-response association between transportation noise exposure and type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies

AIMS

To examine the longitudinal association between transportation noise exposure (road traffic, aircraft, and railway noise) and T2D in a meta-analysis.

MATERIALS AND METHODS

We systematically searched PubMed, Embase, Scopus, Cochrane, and Web of Science published up to February 2022. The GRADE approach was used to evaluate the study quality, and the pooled effect estimate was calculated by the fixed-effects model or the random-effects model.

RESULTS

We included 10 prospective studies with a total of 4,994,171 participants and 417,332 T2D cases in the meta-analysis. According to the Navigation guide, 8 studies out of 10 were rated as having a probably high or high risk of bias. For road noise, the pooled relative risk (RR) per 10 dB higher L_den for developing T2D was 1.06 (95% CI:1.03, 1.09) with high heterogeneity (I²  = 90.1%, p < 0.001). Similar associations were also observed in aircraft and railway noise: the pooled RR were separately were: 1.01 (1.00, 1.01) and 1.02 (1.01, 1.03) separately. A 'dose-response' analysis found a similar linear association between road noise exposure and the risk of T2D.

CONCLUSIONS

An overall 6% increase in the risk of T2D per 10 dB increase in road exposure was observed. Further studies are needed to confirm our findings, especially for aircraft and railway noise, and to identify the mechanisms involved.

Long-term exposure to transportation noise and risk of type 2 diabetes: A cohort study

BACKGROUND

Some studies have found transportation noise to be associated with higher diabetes risk. This includes studies based on millions of participants, relying entirely on register-based confounder adjustment, which raises concern about residual lifestyle confounding. We aimed to investigate associations between noise and type 2 diabetes (T2D), including investigation of effects of increasing confounder adjustment for register-data and lifestyle.

METHODS

In a cohort of 286,151 participants randomly selected across Denmark in 2010-2013 and followed up until 2017, we identified 7574 incident T2D cases. Based on residential address-history for all participants linked with exposure assessment of high spatial resolution, we calculated 10-year time-weighted mean road and railway noise at the most (LdenMax) and least (LdenMin) exposed façades and air pollution (PM_2.5). We used Cox models to calculate hazard ratios (HR) with increasing adjustment for individual- and area-level register-based sociodemographic covariates, self-reported lifestyle and air pollution.

RESULTS

We found that a 10 dB increase in 10-year mean road LdenMin was associated with HRs (95% CI) of 1.06 (1.02-1.10) after adjustment for age, sex and year, 1.08 (1.04-1.13) after further adjustment for register-based sociodemographic covariates, 1.07 (1.03-1.12) after further lifestyle adjustment (e.g. smoking, diet and alcohol) and 1.06 (1.02-1.11) after further PM_2.5 adjustment. For road LdenMax, the corresponding HRs were 1.07 (1.04-1.10), 1.05 (1.02-1.08), 1.04 (1.01-1.07) and 1.03 (1.00-1.06). Railway noise was associated with HRs of 1.04 (0.98-1.11) for LdenMax and 1.02 (0.92-1.12) for LdenMin after adjustment for sociodemographic and lifestyle covariates and PM_2.5.

CONCLUSIONS

Long-term exposure to road traffic noise was associated with T2D, which together with previous literature indicates that T2D should be considered when calculating health impacts of noise. After sociodemographic adjustment, further lifestyle adjustment only changed HRs slightly, suggesting that large register-based studies with adjustment for key sociodemographic covariates can produce reliable results.

Associations between a Subjective Living Environment and Quality of Life among People with Arterial Hypertension-Results from the Hamburg City Health Study

Hypertension is a global public health concern and an important contributor to cardiovascular disease. It remains disputed how important life circumstances are for the etiology of hypertension. Thus, the aim of this study is to assess the spatial variation of hypertension within an urban population and to investigate the association with the quality of life of city dwellers and their subjective evaluation of their residential district, as well as their home environment, using the example of Hamburg, Germany. In this cross-sectional study, the first 10,000 participants from the Hamburg City Health Study (HCHS) were analysed. Only participants who had resided at the current address for a minimum of five years were considered. In the descriptive analysis, participants with and without arterial hypertension were compared considering various parameters. The subjective quality of the living environment was obtained using an appropriate subjective living environment index. Quality of life was mapped using the EuroQol Group quality of life questionnaire (EQ-5D) score and the two (mental and physical health) scores of the Short Form Health Questionnaire SF-8. The Gini-coefficient was used to quantify the regional economic variation within Hamburg. Linear and logistic regression analyses were performed. Regional levels were 68 city district clusters in Hamburg. The analysis included n = 8192 participants living at least five years in Hamburg at the time of participation in the HCHS. There was a spatial variation in the prevalence of arterial hypertension within Hamburg. Prevalence rates between city district clusters ranged from 50.0% to 88.5%. The results showed that city district clusters with a worse subjective perception of the living environment were partly associated with an increased prevalence of arterial hypertension. Furthermore, a negative association was observed between arterial hypertension prevalence and the sociodemographic status of participants in the city district clusters. Thus, participants with a high level of education suffered less frequently from arterial hypertension than participants with a rather low level of education. The subjective living environment index and quality of life were significantly related to the occurrence of arterial hypertension; however, more extensive and detailed studies are necessary to derive possible clinical implications.

Air pollution, road traffic noise and lack of greenness and risk of type 2 diabetes: A multi-exposure prospective study covering Denmark

OBJECTIVE

Air pollution, road traffic noise and lack of greenness coexist in urban environments and have all been associated with type 2 diabetes. We aimed to investigate how these co-exposures were associated with type 2 diabetes in a multi-exposure perspective.

METHODS

We estimated 5-year residential mean exposure to fine particles (PM_2.5), ultrafine particles (UFP), elemental carbon (EC), nitrogen dioxide (NO₂) and road traffic noise at the most (LdenMax) and least (LdenMin) exposed facade for all persons aged > 50 years living in Denmark in 2005 to 2017. For each air pollutant, we estimated total concentrations and traffic contributions. Based on land use maps, we estimated proportion of green and non-green space within 150 and 1000 m of all residences. In total, 1.9 million persons were included and 128,358 developed type 2 diabetes during follow-up. We performed analyses using Cox proportional hazards models, with adjustment for individual and neighborhood-level sociodemographic co-variates.

RESULTS

In single-pollutant models, all air pollutants, noise and lack of green space were associated with higher risk of diabetes. In two-, three- and four-pollutant analyses of the air pollutants, only UFP and NO₂ remained associated with higher diabetes risk in all models. LdenMax, LdenMin and the two proxies of green space remained associated with diabetes in two-pollutant models of, respectively, noise and green space. In a multi-pollutant analysis, we found hazard ratios (95 % confidence intervals) per interquartile range of 1.021 (1.005; 1.038) for UFP, 1.012 (0.996; 1.028) for NO₂, 1.022 (1.012; 1.033) for LdenMin, 1.013 (1.004; 1.022) for LdenMax, and 1.038 (1.031; 1.044) and 1.018 (1.010; 1.025) for lack of green space within, respectively, 150 m and 1000 m, and a cumulative risk index of 1.131 (1.113; 1.149).

CONCLUSIONS

Air pollution, road traffic noise and lack of green space were independently associated with higher risk of type 2 diabetes.

Road Traffic Noise, Obesity, and the Risk of Incident Type 2 Diabetes: A Cohort Study in UK Biobank

Objectives: To assess the association of road traffic noise exposure with Type 2 Diabetes (T2D) risk, and to explore the potential moderation effect of obesity. Methods: A total of 305,969 participants from the UK Biobank Cohort - an open access cohort of 500,000 participants recruited in the United Kingdom (UK) between 2006 and 2010 - were included in the study. A Cox proportional hazard model was fitted to assess the association between road traffic noise exposure and T2D. Results: A total of 19,303 participants were diagnosed with T2D during the 11.9-year median follow-up period. For every 10 dB increase in road traffic noise, there was a 4% increase in T2D risk (HR = 1.04, 95%CI: 1.01, 1.07). Besides, a significant positive interaction was observed between obesity and road traffic noise (P interaction <0.001) for the risk of T2D. The association of road traffic noise with T2D was stronger in overweight and obese participants (HR = 1.04, 95% CI: 1.01-1.08), but not significant among lean ones (HR = 0.96, 95% CI: 0.86-1.07). Conclusion: Our study observed a longitudinal association of road traffic noise exposure with T2D risk, which was stronger among overweight and obese individuals than the lean ones.

The effects of indoor plants and traffic noise on English reading comprehension of Chinese university students in home offices

Owing to the COVID-19 pandemic, working from home promotes the importance of indoor environment qualities. With the settings and functions of home offices, an experiment was carried out to determine the interaction effects between indoor plants and traffic noise levels (TNLs) on the performance and environmental evaluations of English reading comprehension tasks (ERCTs) and the performance of short-term breaks. A sample of 22 Chinese university students (12 males and 10 females) took part in the experiment. Two visual conditions (with and without plants) and five TNLs (i.e., 35, 45, 50, 55, and 60 dBA TNL) were included. Participants’ accuracy rates, eye movements, mental workload, and feelings about the environment were collected. The mental fatigue recovery (MFR), visual fatigue recovery (VFR), anxiety recovery (AR), and unfriendly recovery (UR) were measured for the analysis of a 5-min short-term break. The results demonstrate (1) plants have significant effects on ERCTs and short-term breaks, especially at 45 and 50 dBA TNL; (2) the effects of TNLs on ERCTs’ eye movements and work environment satisfaction differ by the presence of plants, e.g., the average pupil diameter (APD), lighting and layout satisfaction; (3) The effects of indoor plants on ERCT differ by the range of TNLs. In conclusion, indoor plants are beneficial to home workers engaged in ERCT when TNL does not exceed 50 dBA. The current data highlight the importance of audio-visual interaction in home offices and provide insights into the interaction mechanism between indoor plants and traffic noise.

Risk of Hypertension and Type 2 Diabetes in Relation to Changes in Alcohol Consumption: A Nationwide Cohort Study

Little is known about the risk of hypertension and type 2 diabetes in relation to changes in frequency and amount of alcohol consumption. This study investigated associations between changes in alcohol consumption and the risk of both conditions. This study included 96,129 individuals without hypertension and/or diabetes mellitus aged ≥ 20 years between 2006 and 2008, with follow-up until 31 December 2015. This study identified 29,043 and 18,784 incident cases of hypertension and type 2 diabetes, respectively, during an average follow-up period of 6.2 ± 2.6 and 6.9 ± 1.9 years. This study measured changes in frequency and amount of alcohol consumption using standardized self-administered questionnaires over approximately 2 years. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the respective risks of the two conditions. Repeated occasional or frequent binge drinking was associated with an increased risk of hypertension (HR: 1.16 or 1.32; 95% CI: 1.11, 1.21 or 1.16, 1.51) and type 2 diabetes (HR: 1.14 or 1.36; 95% CI: 1.09, 1.20 or 1.17, 1.58) compared with continuous nondrinking. Reductions as well as increases in frequency of alcohol consumption among binge drinkers were associated with higher hypertension (HR: 1.29 or 1.30; 95% CI: 1.11, 1.49 or 1.13, 1.49) and type 2 diabetes (HR: 1.26 or 1.56; 95% CI: 1.06, 1.49 or 1.34, 1.81) risk. This study demonstrated that repeated binge drinking, even with a reduction of weekly alcohol consumption frequency, was associated with a higher risk of hypertension and type 2 diabetes.

Residential area greenness and hypertension: a national assessment on urban adults in Bangladesh

This study investigated the associations between greenness and blood pressure (BP) metrics (systolic BP [SBP], diastolic BP [DBP], hypertension) among urban adults in Bangladesh and the potential mediation effects of body mass index (BMI) using 2011 Bangladesh Demographic and Health Survey data for 2360 urban adults (aged ≥35 years). The Enhanced Vegetation Index was used as a measure of residential area greenness. Associations between greenness and BP metrics were estimated using linear and binary logistic regression models. We also conducted mediation analyses. Greater area-level greenness was inversely associated with SBP (β -1.33, 95%CI: -2.46, -.20), DBP (β -.83, 95%CI: -1.64, -.02), and hypertension (adjusted odds ratio .87, 95%CI: .77, .98). BMI substantially mediated associations between greenness and BP metrics. Adopting urban greening policies could reduce the risk of hypertension, thus can contribute to reduction of non-communicable disease burden in Bangladesh. Longitudinal studies are required to further investigate the causal pathways.

Effects of the COVID-19 lockdown and recovery on People's mobility and air quality in the United Arab Emirates using satellite and ground observations

The stringent COVID-19 lockdown measures in 2020 significantly impacted people's mobility and air quality worldwide. This study presents an assessment of the impacts of the lockdown and the subsequent reopening on air quality and people's mobility in the United Arab Emirates (UAE). Google's community mobility reports and UAE's government lockdown measures were used to assess the changes in the mobility patterns. Time-series and statistical analyses of various air pollutants levels (NO₂, O₃, SO₂, PM₁₀, and aerosol optical depth-AOD) obtained from satellite images and ground monitoring stations were used to assess air quality. The levels of pollutants during the initial lockdown (March to June 2020) and the subsequent gradual reopening in 2020 and 2021 were compared with their average levels during 2015-2019. During the lockdown, people's mobility in the workplace, parks, shops and pharmacies, transit stations, and retail and recreation sectors decreased by about 34%-79%. However, the mobility in the residential sector increased by up to 29%. The satellite-based data indicated significant reductions in NO₂ (up to 22%), SO₂ (up to 17%), and AOD (up to 40%) with small changes in O₃ (up to 5%) during the lockdown. Similarly, data from the ground monitoring stations showed significant reductions in NO₂ (49% - 57%) and PM₁₀ (19% - 64%); however, the SO₂ and O₃ levels showed inconsistent trends. The ground and satellite-based air quality levels were positively correlated for NO₂, PM₁₀, and AOD. The data also demonstrated significant correlations between the mobility and NO₂ and AOD levels during the lockdown and recovery periods. The study documents the impacts of the lockdown on people's mobility and air quality and provides useful data and analyses for researchers, planners, and policymakers relevant to managing risk, mobility, and air quality.

Ammonium nitrate explosion at the main port in Beirut (Lebanon) and air pollution: an analysis of the spatiotemporal distribution of nitrogen dioxide

An explosion of the ammonium nitrate (AN) stored at Beirut Port devastated the city on Tuesday 4 August 2020. Such an explosion produces pollutants such as nitrogen oxides (NO _x ). The most common NO _x is nitrogen dioxide (NO₂), which is present in the atmosphere due to natural and anthropogenic processes. The presence of NO₂ is used as indicator of air pollution. However, the specific contribution of NO₂ to air quality is uncertain due to the presence of other constituents, especially particulate matter (PM10). Research has shown that extended exposure to NO₂ may result in serious health effects. This study investigated the impact of the explosion on NO₂ levels in the atmosphere above Beirut and the surrounding area. NO₂ data from the Sentinel-5P program were used to map the levels of NO₂. Furthermore, ground-monitoring data were used to assess the levels of PM10 and ozone (O₃) due to the evident association between these constituents and NO₂. Results showed that NO₂ levels were higher than before the blast. However, 7 days after the explosion, NO₂ levels had returned to normal, while the levels of PM10 and O₃ remained normal following the explosion. However, a slight increase in the daily average atmospheric pressure was noticed after the explosion, which was attributed to the decomposition of ammonium nitrate.

Environmental heterogeneity in human health studies. A compositional methodology for Land Use and Land cover data

The use of Land use and Land cover (LULC) data is gradually becoming more widely spread in studies relating the environment to human health. However, little research has acknowledged the compositional nature of these data. The goal of the present study is to explore, for the first time, the independent effect of eight LULC categories (agricultural land, bare land, coniferous forest, broad-leaved forest, sclerophyll forest, grassland and shrubs, urban areas, and waterbodies) on three selected common health conditions: type 2 diabetes mellitus (T2DM), asthma and anxiety, using a compositional methodological approach and leveraging observational health data of Catalonia (Spain) at area level. We fixed the risk exposure scenario using three covariates (socioeconomic status, age group, and sex). Then, we assessed the independent effect of the eight LULC categories on each health condition. Our results show that each LULC category has a distinctive effect on the three health conditions and that the three covariates clearly modify this effect. This compositional approach has yielded plausible results supported by the existing literature, highlighting the relevance of environmental heterogeneity in health studies. In this sense, we argue that different types of environment possess exclusive biotic and abiotic elements affecting distinctively on human health. We believe our contribution might help researchers approach the environment in a more multidimensional manner integrating environmental heterogeneity in the analysis.

Impact of Noise Exposure on Risk of Developing Stress-Related Health Effects Related to the Cardiovascular System: A Systematic Review and Meta-Analysis

Background

: Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses.

Materials and Methods

This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

: The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects.

Conclusions

: This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.

Associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents

BACKGROUND

Epidemiologic evidence linking environmental noise to obesity and hypertension remains scarce, especially in children, and the results remain inconclusive. This study aims to examine the cross-sectional associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents.

METHODS

As an ongoing study, a representative sample of the children aged 6-9 years in Chongqing were selected in 2014. In 2019, self-reported residential noise (answer categories: "very quiet," "moderately quiet," "slightly quiet," and "not at all quiet") data were collected, and 3,412 participants with completed data were included in the analyses.

RESULTS

Participants living in a quieter area had a significantly lower risk of obesity than those living in a noisy area (very quiet: OR = 0.50, 95%CI: 0.29-0.88, P = 0.015; moderately quiet: OR = 0.61, 95%CI: 0.36-1.02, P = 0.059). Similar associations were observed for abdominal obesity, although did not reach statistical significance. Consistently, residential noise exposure was significantly associated with body mass index (BMI) and waist-to-height ratio. Self-reported residential noise exposure was positively associated with systolic blood pressure (β = -1.808; 95%CI = -3.495, -0.110; P = 0.037). When sleep quality, study stress, BMI, and vegetable/fruits consumption were further adjusted, all effect estimates decreased, and no statistical association was observed between noise exposure and blood pressure. Furthermore, we found that the mediating effects of obesity on the associations of self-reported residential noise exposure with hypertension were 6.8% (% of total effect mediated = 0.068, 95%CI: -2.58, 3.99), although did not reach statistical significance.

CONCLUSIONS

Self-reported residential noise exposure was associated with a higher risk of obesity or abdominal obesity. Also, self-reported residential noise exposure was positively associated with hypertension, and obesity may partially mediate this association, but did not reach statistical significance.

Shock effect of COVID-19 infection on environmental quality and economic development in China: causal linkages (Health Economic Evaluation)

Since coronavirus disease 2019 (COVID-19) was first reported on December 2019 in Wuhan, it fast spread to the rest of China, which has turned into a global public health problem later and generated global stock markets to violently shake. We inspect the causal relationships between economic development (ED) and environmental quality (EQ) during the period from January 2019 to May 2020 with the structural break for China and investigate the causal linkages between ED and EQ in subgroup of before and after the outbreak of COVID-19 with a semi-parametric model. The empirical tests show that smoothing structural transforms matter for the linkages of causality between ED and EQ, especially after COVID-19 infection. While the Toda-Yamamoto causality analysis supports unidirectional causality between ED and EQ before the outbreak of COVID-19, under structural shifts by the causality supplies of bidirectional casual linkages after the outbreak of COVID-19. Our results further clarified the proof that the economic activity gives rise to the environmental pollution and energy utilization mainly via the shock of COVID-19 in China. The emphasis on nonlinear causality between economic development and environmental quality may be an opportunity for China's economic recovery under considering the factor of COVID-19 infection.

Transportation noise exposure and cardiovascular mortality: 15-years of follow-up in a nationwide prospective cohort in Switzerland

BACKGROUND

Death from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source.

METHODS

Road traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM_2.5, adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group.

RESULTS

During a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024-1.034), 1.013 (1.010-1.017), and 1.003 (0.996-1.010) per 10 dB L_den, respectively. Associations for MI mortality were a respective 1.043 (1.029-1.058), 1.020 (1.010-1.030) and 1.040 (1.020-1.060) per 10 dB L_den. Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40 dB L_den for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females.

CONCLUSION

Independent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits.

Long-Term Exposure to Transportation Noise and Risk for Type 2 Diabetes in a Nationwide Cohort Study from Denmark

BACKGROUND

Epidemiologic studies have linked transportation noise to increased morbidity and mortality, particularly for cardiovascular outcomes. However, studies investigating metabolic outcomes such as diabetes are limited and have focused only on noise exposures estimated for the loudest residential façade.

OBJECTIVES

We aimed to examine the influence of long-term residential exposure to transportation noise at the loudest and quietest residential façades and the risk for type 2 diabetes.

METHODS

Road traffic and railway noise exposures (Lden) at the most and least exposed façades were estimated for all dwellings in Denmark during 1990-2017. Aircraft noise was estimated in 5-dB categories. Ten-year time-weighted mean noise exposures were estimated for 3.56 million individuals ≥35 years of age. From 2000 to 2017, 233,912 incident cases of type 2 diabetes were identified using hospital and prescription registries, with a mean follow-up of 12.9 y. We used Cox proportional hazards models adjusting for individual- and area-level covariates and long-term residential air pollution. The population-attributable fraction (PAF) was also computed.

RESULTS

Hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes in association with 10-dB increases in 10-y mean road traffic noise at the most and least exposed façades, respectively, were 1.05 (95% CI: 1.04, 1.05) and 1.09 (95% CI: 1.08, 1.10). Following subsequent adjustment for fine particulate matter [particulate matter ≤2.5μm in aerodynamic diameter] (10-y mean), the HRs (CIs) were 1.03 (95% CI: 1.03, 1.04) and 1.08 (95% CI: 1.07, 1.09), respectively. For railway noise, the HRs per 10-dB increase in 10-y mean exposure were 1.03 (95% CI: 1.02, 1.04) and 1.02 (95% CI: 1.01, 1.04) for the most and least exposed façades, respectively. Categorical models supported a linear exposure-outcome relationship for road traffic noise and, to a lesser extent, for railway noise. Aircraft noise >45 dB was associated with a 1-4% higher likelihood of type 2 diabetes compared with those who were unexposed. We found road traffic and railway noise associated with a PAF of 8.5% and 1.4%, respectively, of the diabetes cases.

DISCUSSION

Long-term exposure to road, railway, and possibly aircraft traffic noise was associated with an increased risk of type 2 diabetes in a nationwide cohort of Danish adults. Our findings suggest that diabetes should be included when estimating the burden of disease due to transportation noise. https://doi.org/10.1289/EHP9146.

Urban Noise Exposure and Cardiometabolic Diseases: An Exploratory Cross-Sectional Study in Lisbon

Introduction: Urban noise pollution has been associated with an increased risk of developing metabolic syndrome. Nevertheless, existing observational studies relating to noise exposure and metabolic syndrome are based on non-generalizable cohorts. Lisbon remains a noisy city where this association has not been evaluated, and for this reason, we studied the relationship between exposure to urban noise and the prevalence of type 2 diabetes mellitus, obesity, and hypertension. Methods: Diurnal, evening and nocturnal noise emission levels were obtained for each street in the city from the Lisbon noise map. After allocation of all roads to the respective parish of Lisbon, the noise emission for each parish was averaged for each day period. The number of adult patients with type 2 diabetes mellitus, obesity and hypertension in 2014, 2015 and 2016 in each parish of Lisbon was obtained from the Regional Health Administration of Lisbon and Tagus Valley. Prevalence as a percentage of the population was determined using the number of residents in each parish determined in the 2011 population census. Spearman’s non-parametric correlation coefficient was used due to the non-normal distribution of the variables, at the 5% significance level (α = 0.05). Results: No correlations were found between daytime, afternoon or night-time noise exposure and the prevalence of type 2 diabetes mellitus, obesity or hypertension, although correlations were found between the cardiometabolic variables. Nevertheless, noise levels in Lisbon were above the legally established limit and the World Health Organization guidelines for environmental noise exposure in the European region. Conclusion: Our results do not agree with previous studies and should be faced as preliminary due to a strong biological plausibility for an association between noise exposure and cardiometabolic diseases and to encourage further studies, with longitudinal cohorts.

Long-Term Exposure to Air Pollution, Road Traffic Noise, and Heart Failure Incidence: The Danish Nurse Cohort

Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO₂ and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m³ in particulate matter with a diameter <2.5 µm, 8.6 µg/m³ in NO₂, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (P_{effect modification}<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.

Association between long term exposure to particulate matter and incident hypertension in Spain

Exposure to air particulate matter has been linked with hypertension and blood pressure levels. The metabolic risks of air pollution could vary according to the specific characteristics of each area, and has not been sufficiently evaluated in Spain. We analyzed 1103 individuals, participants in a Spanish nationwide population based cohort study (di@bet.es), who were free of hypertension at baseline (2008-2010) and completed a follow-up exam of the cohort (2016-2017). Cohort participants were assigned air pollution concentrations for particulate matter < 10 μm (PM₁₀) and < 2.5 μm (PM_2.5) during follow-up (2008-2016) obtained through modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). Mean and SD concentrations of PM₁₀ and PM_2.5 were 20.17 ± 3.91 μg/m³ and 10.83 ± 2.08 μg/m³ respectively. During follow-up 282 cases of incident hypertension were recorded. In the fully adjusted model, compared with the lowest quartile of PM_10, the multivariate weighted ORs (95% CIs) for developing hypertension with increasing PM₁₀ exposures were 0.82 (0.59-1.14), 1.28 (0.93-1.78) and 1.45 (1.05-2.01) in quartile 2, 3 and 4 respectively (p for a trend of 0.003). The corresponding weighted ORs according to PM_2.5 exposures were 0.80 (0.57-1.13), 1.11 (0.80-1.53) and 1.48 (1.09-2.00) (p for trend 0.004). For each 5-μg/m³ increment in PM₁₀ and PM_2.5 concentrations, the odds for incident hypertension increased 1.22 (1.06-1.41) p = 0.007 and 1.39 (1.07-1.81) p = 0.02 respectively. In conclusion, our study contributes to assessing the impact of particulate pollution on the incidence of hypertension in Spain, reinforcing the need for improving air quality as much as possible in order to decrease the risk of cardiometabolic disease in the population.

A neurobiological link between transportation noise exposure and metabolic disease in humans

BACKGROUND

Chronic transportation noise exposure associates with cardiovascular events through a link involving heightened stress-associated neurobiological activity (as amygdalar metabolic activity, AmygA) on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT). Increased AmygA also associates with greater visceral adipose tissue (VAT) and type 2 diabetes mellitus (DM). While relationships between noise exposure and VAT and DM have been reported, the underlying mechanisms remain incompletely understood. We tested whether: (1) transportation noise exposure associates with greater (a) baseline and gains in VAT and (b) DM risk, and (2) heightened AmygA partially mediates the link between noise exposure and these metabolic diseases.

METHODS

VAT was measured in a retrospective cohort (N = 403) who underwent clinical ¹⁸F-FDG-PET/CT. AmygA was measured in those with brain imaging (N = 238). Follow-up VAT was remeasured on available imaging (N = 67). Among individuals (N = 224) without baseline DM, incident DM was adjudicated over 2 years from clinical records. Noise (24-h average) was modeled at each individual's home address. Linear regression, survival, and mediation analyses were employed.

RESULTS

Higher noise exposure (upper tertile vs. others) associated with greater: baseline VAT (standardized β [95% confidence interval (CI)]= 0.230 [0.021, 0.438], p = 0.031), gains in VAT (0.686 [0.185, 1.187], p = 0.008 adjusted for baseline VAT), and DM (hazard ratio [95% CI]=2.429 [1.031, 5.719], p = 0.042). The paths of: ↑noise exposure→↑AmygA→↑baseline VAT and ↑noise exposure→↑AmygA→↑subsequent DM were significant (p < 0.05).

CONCLUSIONS

Increased transportation noise exposure associates with greater VAT and DM. This relationship is partially mediated by stress-associated neurobiological activity. These findings suggest altered neurobiology contributes to noise exposure's link to metabolic diseases.

Association between air pollution and COVID-19 infection: evidence from data at national and municipal levels

The impact of high concentrations of air pollution on COVID-19 has been a major air quality and life safety issue in recent studies. This study aimed to assess the contribution of different air pollution indicators in different spaces on the newly confirmed cases of coronavirus. According to causality's results between air pollution (AP) and COVID-19 infection in 9 countries, first, we examined the non-linear relationship from AP to COVID-19 with PM2.5 as the rating variable (the cut point is 35 μg/m3) at the national level. It is concluded that the effects of PM2.5 and PM10 on COVID-19 are more sensitive in Russia, England, Germany, and France, while O3 and PM2.5 are more sensitive in America and Canada from 21 Jan to 20 May. Second, we examined the threshold effects from AP to COVID-19 with PM2.5, PM10, SO2, CO, NO2, and O3 as the threshold variables, respectively, at the municipal level in China during the period 28 Jan to 31 May. It is concluded that except CO, the remaining 5 indicators are very sensitive to the increase of newly confirmed cases, and the spread of COVID-19 can be prevented and controlled by the determination of thresholds. In addition, the 9 countries and 27 provinces show that PM2.5 in high concentrations is the more sensitive pollutant on the spread of COVID-19 infection.

Road traffic noise and cardiovascular disease risk factors in UK Biobank

AIMS

The aim of this study was to investigate the cross-sectional associations of modelled residential road traffic noise with cardiovascular disease risk factors [systolic (SBP) and diastolic blood pressure (DBP), C-reactive protein, triglycerides, glycated haemoglobin, and self-reported hypertension] in UK Biobank.

METHODS AND RESULTS

The UK Biobank recruited 502 651 individuals aged 40-69 years across the UK during 2006-10. Road traffic noise (Lden and Lnight) exposure for 2009 was estimated at baseline address using a simplified version of the Common Noise Assessment Methods model. We used multivariable linear and logistic regression models, adjusting for age, sex, body mass index (BMI), smoking, alcohol intake, area- and individual-level deprivation, season of blood draw, length of time at residence, and nitrogen dioxide (main model), in an analytical sample size of over 370 000 participants. Exposure to road-traffic Lden >65 dB[A], as compared to ≤55 dB[A], was associated with 0.77% [95% confidence interval (CI) 0.60%, 0.95%], 0.49% (95% CI 0.32%, 0.65%), 0.79% (95% CI 0.11%, 1.47%), and 0.12% (95% CI -0.04%, 0.28%) higher SBP, DBP, triglycerides, and glycated haemoglobin, respectively. Removing BMI from the main model yielded significant positive associations with all five markers with elevated percent changes. The associations with SBP or DBP did not appear to be impacted by hypertension medication while a positive association with prevalent self-reported hypertension was seen in the non-medicated group who exposed to a Lden level of 60-65 dB[A] (odds ratio 1.07, 95% CI 1.00, 1.15).

CONCLUSION

Exposure to road traffic noise >65 dB[A], independent of nitrogen dioxide, was associated with small but adverse changes in blood pressure and cardiovascular biochemistry.

Assessment of air pollution status during COVID-19 lockdown (March-May 2020) over Bangalore City in India

The coronavirus disease 2019 (COVID-19), which became a global pandemic by March 2020, forced almost all countries over the world to impose the lockdown as a measure of social distancing to control the spread of infection. India also strictly implemented a countrywide lockdown, starting from 24 March to 12 May 2020. This measure resulted in the reduction of the sources of air pollution in general: industrial, commercial, and vehicular pollution in particular, with visible improvement in ambient air quality. In this study, the impact of COVID-19 lockdown on the ambient concentration of air pollutants over the city of Bangalore (India) is assessed using Continuous Ambient Air Quality Measurement (CAAQM) data from 10 monitoring stations spread across the city. The data was obtained from Central Pollution Control Board (CPCB) and Karnataka State Pollution Control Board (KSPCB). The analysis of the relative changes in the ambient concentration of six major air pollutants (NO, NO₂, NO_X, PM_2.5, O₃, and SO₂) has been carried out for two periods: March-May 2020 (COVID-19 lockdown) and the corresponding period of 2019 during when there was no lockdown. The analysis revealed significant reduction in the concentration of ambient air pollutants at both daily and monthly intervals. This can be attributed to the reduction in sources of emission; vehicular traffic, industrial, and other activities. The average reduction in the concentration of NO, NO₂, NO_X, PM_2.5, and O₃ between 01 March and 12 May 2020 was found to be 63%, 48%, 48%, 18%, and 23% respectively when compared to the same period in 2019. Similarly, the comparative analysis of pollutant concentrations between pre-lockdown (01-23 March 2020) and lockdown (24 March-12 May 2020) periods has shown a huge reduction in the ambient concentration of air pollutants, 47.3% (NO), 49% (NO₂), 49% (NO_X), 10% (SO₂), 37.7% (PM_2.5), and 15.6% (O₃), resulting in improved air quality over Bangalore during the COVID-19 lockdown period. It is shown that the strict lockdown resulted in a significant reduction in the pollution levels. Such lockdowns may be useful as emergency intervention strategies to control air pollution in megacities when ambient air quality deteriorates dangerously.

Multimodality molecular imaging: Gaining insights into the mechanisms linking chronic stress to cardiovascular disease

Positron emission tomography (PET) imaging can yield unique mechanistic insights into the pathophysiology of atherosclerosis. 18F-fluorodeoxyglucose (18F-FDG), a radiolabeled glucose analog, is retained by cells in proportion to their glycolytic activity. While 18F-FDG accumulates within several cell types in the arterial wall, its retention correlates with macrophage content, providing an index of arterial inflammation (ArtI) which predicts subsequent cardiovascular disease (CVD) events. Furthermore, 18F-FDG-PET imaging allows the simultaneous assessment of metabolic activity in several tissues (e.g., brain, bone marrow) and is performed in conjunction with cross-sectional imaging that enables multi-organ structural assessments. Accordingly, 18F-FDG-PET/computed tomography (CT) imaging facilitates evaluation of disease pathways that span multiple organ systems. Within this paradigm, 18F-FDG-PET/CT imaging has been implemented to study the mechanism linking chronic stress to CVD. To evaluate this, stress-associated neural activity can be quantified (as metabolic activity of the amygdala (AmygA)), while leukopoietic activity, ArtI, and coronary plaque burden are assessed concurrently. Such simultaneous quantification of tissue structures and activities enables the evaluation of multi-organ pathways with the aid of mediation analysis. Using this approach, multi-system 18F-FDG-PET/CT imaging studies have demonstrated that chronically heightened stress-associated neurobiological activity promotes leukopoietic activity and systemic inflammation. This in turn fuels more ArtI and greater non-calcified coronary plaque burden, which result in more CVD events. Subsequent studies have revealed that common stressors, such as chronic noise exposure and income disparities, drive the front end of this pathway to increase CVD risk. Hence, multi-tissue multimodality imaging serves as a powerful tool to uncover complex disease mechanisms.

The impact of COVID-19 pandemic on nitrogen dioxide levels in Nigeria

The Coronavirus disease (COVID-19) has been transmitted worldwide over a very short time after it originated in China in December 2019. In an attempt to control its spread and reduce its health impacts, several countries including those in the African continent imposed restrictive measures that was termed "lockdown". The outcomes of this lockdown have been reported to be beneficial to air quality worldwide. The main objective of this study is to assess the impact of lockdown due to COVID-19 on nitrogen dioxide (NO2) levels over six major cities in Nigeria. Maps extracted from satellite (Sentinel-5P) were used to indicate the significant reduction in the level of NO2 in the selected cities in Nigeria during two time-intervals, pre-lockdown (December, 2019) and during lockdown (April, 2020). The results show a significant reduction in NO2 levels during the lockdown period compared with its levels during the pre-lockdown period in 2019. The reduction in NO2 concentration levels during lockdown is likely due to less traffic, social distancing and restrictions on business and human activities. There could be an element of uncertainty in the results due to seasonality, as the comparison is done with a different season. However, the magnitude of change due to lockdown is probably much higher than the seasonal variability. Although COVID-19 has negatively impacted the health and economic status of all regions worldwide, it has benefited some aspects of air quality in most countries including Nigeria. This indicates that anthropogenic activities may be managed to reduce air pollution and positively impact the health of human beings.

Indoor nocturnal noise is associated with body mass index and blood pressure: a cross-sectional study

BACKGROUND

Studies have demonstrated that noise is associated with various health problems, such as obesity and hypertension. Although the evidence of the associations of noise with obesity and hypertension is inconsistent, there seems to be a stronger association of the latter. This study aimed to investigate the associations of noise with body mass index (BMI) and blood pressure in adults living in multi-story residential buildings.

METHODS

A cross-sectional study was conducted in Hong Kong from February 2018 to September 2019. The Weinstein Noise Sensitivity Scale, Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered to the participants. BMI and blood pressure were assessed. Nocturnal noise exposure and total sleep duration were measured for a week.

RESULTS

Five hundred adults (66.4% female), with an average age of 39 years (range: 18-80), completed the study. The average levels of nocturnal noise, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 51.3 dBA, 22.2 kg/m2, 116.0 mmHg, and 75.4 mmHg, respectively. After adjusting for sociodemographic characteristics, nocturnal noise was associated with BMI (b = 0.54, 95% CI: 0.01 to 1.06, p = 0.045) and SBP (b = 2.90, 95% CI: 1.12 to 4.68, p = 0.001). No association was detected between nocturnal noise and DBP (b = 0.79, 95% CI: - 0.56 to 2.13, p = 0.253). Specifically, higher nocturnal noise was associated with higher BMI (b = 0.72, 95% CI: 0.07 to 1.38, p = 0.031) and SBP (b = 3.91, 95% CI: 2.51 to 5.31, p < 0.001) in females but only higher SBP (b = 3.13, 95% CI: 1.35 to 4.92, p < 0.001) in males. The association between noise and SBP remained significant (b = 2.41, 95% CI: 0.62 to 4.20, p = 0.008) after additionally adjusting for lifestyle, diagnosis of hypertension, psychometric constructs, and sleep.

CONCLUSIONS

Indoor nocturnal noise was associated with BMI and blood pressure in females but only blood pressure in males. It is important to control nocturnal noise or use soundproofing materials in buildings to reduce noise exposure.

Integrating random forests and propagation models for high-resolution noise mapping

The adverse effects of long-term exposure to environmental noise on human health are of increasing concern. Noise mapping methods such as spatial interpolation and land use regression cannot capture complex relationships between environmental conditions and noise propagation or attenuation in a three-dimension (3D) built environment. In this study, we developed a hybrid approach by combining a traffic propagation model and random forests (RF) machine learning algorithm to map the total environment noise levels for daily average, daytime, nighttime, and day-evening-nighttime at 30 m × 30 m resolution for the island of Montreal, Canada. The propagation model was used to predict traffic noise surfaces using road traffic flow, 3D building information, and a digital elevation model. The traffic noise estimates were compared with ground-based sound-level measurements at 87 points to extract residuals between total environmental noise and traffic noise. Residuals at these points were fit to RF models with multiple environmental and geographic predictor variables (e.g., vegetation index, population density, brightness of nighttime lights, land use types, and distances to noise contour around the airport, bus stops, and road intersections). Using the sound-level measurements as baseline data, the prediction errors, i.e., mean error, mean absolute error, and root mean squared error of daily average noise levels estimated by our hybrid approach was -0.03 dB(A), 2.67 dB(A), and 3.36 dB(A). Combining deterministic and stochastic models can provide accurate total environmental noise estimates for large geographic areas where sound-level measurements are available.

Every breath you take: Impacts of environmental dust exposure on intestinal barrier function-from the gut-lung axis to COVID-19

As countries continue to industrialize, major cities experience diminished air quality, whereas rural populations also experience poor air quality from sources such as agricultural operations. These exposures to environmental pollution from both rural and populated/industrialized sources have adverse effects on human health. Although respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease) are the most commonly reported following long-term exposure to particulate matter and hazardous chemicals, gastrointestinal complications have also been associated with the increased risk of lung disease from inhalation of polluted air. The interconnectedness of these organ systems has offered valuable insights into the roles of the immune system and the micro/mycobiota as mediators of communication between the lung and the gut during disease states. A topical example of this relationship is provided by reports of multiple gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19), whereas the rapid transmission and increased risk of COVID-19 has been linked to poor air quality and high levels of particulate matter. In this review, we focus on the mechanistic effects of environmental pollution on disease progression with special emphasis on the gut-lung axis.

Decrease of mobility, electricity demand, and NO2 emissions on COVID-19 times and their feedback on prevention measures

The spread of coronavirus disease 2019 (COVID-19) on 2020 has affected human activities in a way never documented in modern history. As a consequence of the prevention measures implemented to contain the virus, cities around the world are experiencing a decrease in urban mobility and electricity demand that have positively affected the air quality. The most extreme cases for cities around the world show a decrease of 90, 40, and 70% in mobility, electricity demand, and NO₂ emissions respectively. At the same time, the inspection of these changes along the evaluation of COVID-19 incidence curves allow to obtain feedback about the timely execution of prevention measures for this and future global events. In this case, we identify and discuss the early effort of Latin-American countries to successfully delay the spread of the virus by implementing prevention measures before the fast growth of COVID-19 cases in comparison to European countries.

NO2 levels as a contributing factor to COVID-19 deaths: The first empirical estimate of threshold values

This study represents the first empirical estimation of threshold values between nitrogen dioxide (NO₂) concentrations and COVID-19-related deaths in France. The concentration of NO₂ linked to COVID-19-related deaths in three major French cities were determined using Artificial Neural Networks experiments and a Causal Direction from Dependency (D2C) algorithm. The aim of the study was to evaluate the potential effects of NO₂ in spreading the epidemic. The underlying hypothesis is that NO₂, as a precursor to secondary particulate matter formation, can foster COVID-19 and make the respiratory system more susceptible to this infection. Three different neural networks for the cities of Paris, Lyon and Marseille were built in this work, followed by the application of an innovative tool of cutting the signal from the inputs to the selected target. The results show that the threshold levels of NO₂ connected to COVID-19 range between 15.8 μg/m³ for Lyon, 21.8 μg/m³ for Marseille and 22.9 μg/m³ for Paris, which were significantly lower than the average annual concentration limit of 40 μg/m³ imposed by Directive 2008/50/EC of the European Parliament.

Significant impacts of COVID-19 lockdown on urban air pollution in Kolkata (India) and amelioration of environmental health

The fatal novel coronavirus (COVID-19) pandemic disease smashes the normal tempo of global socio-economic and cultural livelihood. Most of the countries impose a lockdown system with social distancing measures to arrest the rapid transmission of this virus into the human body. The objective of this study is to examine the status of air quality during and pre-COVID-19 lockdown and to recommend some long-term sustainable environmental management plan. The pollution data like PM₁₀, PM_2.5, O₃, SO₂, NO₂ and CO have been obtained from State Pollution Control Board under Govt. of West Bengal. Similarly, various land surface temperature (LST) maps have been prepared using LANDSAT-8 OLI and LANDSAT-7 ETM + images of USGS. The maps of NO₂ and aerosol concentration over Indian subcontinent have been taken from ESA and NASA. The digital thematic maps and diagrams have been depicted by Grapher 13 and Arc GIS 10.3 platforms. The result shows that the pollutants like CO, NO₂ and SO₂ are significantly decreased, while the average level of O₃ has been slightly increased in 2020 during the lockdown due to close-down of all industrial and transport activities. Meanwhile, around 17.5% was the mean reduction of PM₁₀ and PM_2.5 during lockdown compared with previous years owing to complete stop of vehicles movement, burning of biomass and dust particles from the construction works. This study recommends some air pollution-tolerant plant species (in urban vacant spaces and roof tops) for long-term cohabitation among environment, society and development.

A review of current knowledge on Pollution, Cigarette Smoking and COVID-19 diffusion and their relationship with inflammation

Coronavirus disease (COVID-19) is an infectious disease caused by the newly discovered coronavirus, Sars-Cov-2. This infection can cause mild to very severe respiratory and systemic illness mainly related with a cytokine storm. The epidemiology of COVID-19 is under continuous evolution, and studies are ongoing aiming at identifying the possible factors facilitating the diffusion of this infection. (www.actabiomedica.it)

Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality

Nitrogen dioxide (NO₂) is an ambient trace-gas result of both natural and anthropogenic processes. Long-term exposure to NO₂ may cause a wide spectrum of severe health problems such as hypertension, diabetes, heart and cardiovascular diseases and even death. The objective of this study is to examine the relationship between long-term exposure to NO₂ and coronavirus fatality. The Sentinel-5P is used for mapping the tropospheric NO₂ distribution and the NCEP/NCAR reanalysis for evaluating the atmospheric capability to disperse the pollution. The spatial analysis has been conducted on a regional scale and combined with the number of death cases taken from 66 administrative regions in Italy, Spain, France and Germany. Results show that out of the 4443 fatality cases, 3487 (78%) were in five regions located in north Italy and central Spain. Additionally, the same five regions show the highest NO₂ concentrations combined with downwards airflow which prevent an efficient dispersion of air pollution. These results indicate that the long-term exposure to this pollutant may be one of the most important contributors to fatality caused by the COVID-19 virus in these regions and maybe across the whole world.