Association betweenNoiseandCardiovascularDiseaseinaNationwideUS Prospective CohortStudyofWomenFollowedfrom1988to2018

BACKGROUND: Long-term noiseexposureisassociatedwithcardiovasculardisease(CVD), includingacutecardiovasculareventssuchasmyocardial infarction andstroke. However, longitudinalcohortstudiesintheU.S. oflong-termnoiseandCVDarealmostexclusivelyfromEuropeandfewmodeled nighttimenoise, whenanindividualislikelyathomeorasleep, separatelyfromdaytimenoise. Weaimedtoexaminetheprospectiveassociation of outdoorlong-termnighttimeanddaytimenoisefromanthropogenicsourceswithincidentCVDusingaU.S.-based, nationwidecohortofwomen. METHODS: We linkedL50 nighttime andL50 daytime anthropogenicmodelednoiseestimatesfromaU.S. NationalParksServicemodel(L50: soundpressure levelsexceeded50percentofthetime) togeocodedresidentialaddressesof114,116participantsintheNurses' Health Study. Weusedtime-varying Cox proportionalhazardsmodelstoestimateriskofincidentCVD, coronaryheartdisease(CHD), andstrokeassociatedwithlong-termaverage(14-ymeasurement period) noiseexposure, adjustedforpotentialindividual- andarea-levelconfoundersandCVDriskfactors(1988-2018; biennialresidential address updates; monthlyCVDupdates). Weassessedeffect modification bypopulationdensity, region, airpollution, vegetationcover, andneighborhood socioeconomic status, andexploredmediationbyself-reportedaveragenightlysleepduration. RESULTS: Over 2,548,927person-years, therewere10,331incidentCVDevents. Infullyadjustedmodels, thehazardratiosforeachinterquartile range increaseinL50 nighttime noise(3.67dBA) andL50 daytime noise(4.35dBA), respectively, were1.04(95% CI: 1.02,1.06) and1.04(95% CI: 1.02, 1.07). Associationsfortotalenergy-equivalentnoiselevel(Leq) measureswerestrongerthanfortheanthropogenicstatisticalL50 noise measures. SimilarassociationswereobservedforCHDandstroke. InteractionanalysessuggestedthatassociationsofL50 nighttime andL50 daytime noise with CVDdidnotdiffer byprespecified effect modifiers. Wefoundnoevidencethatinadequatesleep(< 5h/night) mediatedassociationsofL50 nighttime noiseandCVD. DISCUSSION: Outdoor L50 anthropogenic nighttimeanddaytimenoiseattheresidentialaddresswasassociatedwithasmallincreaseinCVDriskina cohort ofadultfemalenurses. https://doi.org/10.1289/EHP12906