Cardiometabolic Health Effects of Air Pollution, Noise, Green Space, and Socioeconomic Status: The HERMES Study.

We found that PM_2.5, UFPs, elemental carbon (EC), and nitrogen dioxide (NO₂) were all associated with type 2 diabetes, MI, and stroke in single-pollutant models. However, in multiexposure analyses that included noise and green space, only UFPs for type 2 diabetes and PM_2.5 for MI and stroke remained associated, suggesting that these are the main air pollutants responsible for increasing the risk of cardiometabolic disease. Noise and lack of green space were also associated with cardiometabolic diseases in multiexposure models. We found that air pollution from local traffic was most important for risk of type 2 diabetes, whereas air pollution from other sources was most important for the risk of MI and stroke, which could relate to different air pollution mixtures and/or different biological pathways. Associations between air pollution and type 2 diabetes, MI, and stroke were consistently stronger among individuals with comorbidity, indicating higher susceptibility to negative air pollution effects in this subpopulation. The results of the interaction analyses showed that higher risk estimates among those of low socioeconomic status could be detected when estimating absolute risk but not when estimating relative risk, indicating that the best picture of effect modification is provided when expressed by both relative and absolute risk. The biomarker study showed expected associations between exposure to air pollution and blood lipid levels and blood pressure.