Physics

Internal medicine

Noise reduction

Pollutant

Biology

Noise (video)

Image (mathematics)

Noise pollution

Logistic regression

Artificial intelligence

Acoustics

Ecology

Computer science

Air pollution

Confounding

Traffic noise

Aerodynamic diameter

Environmental science

Pollution

Medicine

Environmental health

Environmental Health Perspectives

Background: Surrounding green, air pollution, and noise have been associated with cardiometabolic diseases, but most studies have assessed only one of these correlated exposures. Objectives: We aimed to evaluate associations of combined exposures to green, air pollution, and road traffic noise with cardiometabolic diseases. Methods: In this cross-sectional study, we studied associations between self-reported physician-diagnosed diabetes, hypertension, heart attack, and stroke from a Dutch national health survey of 387,195 adults and residential surrounding green, annual average air pollutant concentrations [including particulate matter with aerodynamic diameter ≤10μm (PM10), PM with aerodynamic diameter ≤2.5μm (PM2.5), nitrogen dioxide (NO2), and oxidative potential (OP) with the dithiothreitol (DTT) assay (OPDTT)] and road traffic noise. Logistic regression models were used to analyze confounding and interaction of surrounding green, air pollution, and noise exposure. Results: In single-exposure models, surrounding green was inversely associated with diabetes, while air pollutants (NO2, OPDTT) and road traffic noise were positively associated with diabetes. In two-exposure analyses, associations with green and air pollution were attenuated but remained. The association between road traffic noise and diabetes was reduced to unity when adjusted for surrounding green or air pollution. Air pollution and surrounding green, but not road traffic noise, were associated with hypertension in single-exposure models. The weak inverse association of surrounding green with hypertension attenuated and lost significance when adjusted for air pollution. Only PM2.5 was associated with stroke and heart attack. Conclusions: Studies including only one of the correlated exposures surrounding green, air pollution, and road traffic noise may overestimate the association of diabetes and hypertension attributed to the studied exposure. https://doi.org/10.1289/EHP3857

Associations of Combined Exposures to Surrounding Green, Air Pollution, and Road Traffic Noise with Cardiometabolic Diseases