High spatial resolution environmental noise assessment and its associations with risks of cardiovascular diseases based on digital healthcare data in China

Environmental noise pollution is increasing, while risks of cardiovascular diseases (CVD) associated with environmental noise in low- and middle-income countries (LMICs) still remain under-recognized. In this study, we utilized land-use regression (LUR) models at high spatial resolution to assess environmental noise and linked the exposure to digital healthcare data from the Yinzhou Regional Health Information Platform (YRHIP) in China to assess the associations of environmental noise with risks of CVD. Among 533,512 participants, mean (SD) age was 53.66 (15.52) years with females constituting 52.8 %. The mean environmental noise level was 59.34 dB[A]. A total of 177,111 (33.20 %), 18,030 (3.38 %), 15,912 (2.98 %), 9,601 (1.80 %), and 161,889 (30.34 %) participants were diagnosed with CVD, cerebrovascular diseases, ischemic heart diseases (IHD), stroke, and hypertension, respectively. Multivariable modified Poisson regression models incorporating community as a random-effect term were used to evaluate associations of environmental noise with the prevalent risk of CVD and its major subtypes. Individual covariates (age, sex, marital status, education, lifestyles), area-level covariates (urbanicity, population density, GDP), and PM_2.5 were adjusted. We observed positive associations between residential environmental noise exposure and CVD (prevalence ratio (PR) 1.06, 95 % CI: 1.02-1.09 per 5 dB[A]), IHD (PR 1.14, 95 % CI: 1.07-1.21 per 5 dB[A]), and hypertension (PR 1.06, 95 % CI: 1.03-1.09 per 5 dB[A]), while no association was found for cerebrovascular diseases (PR 1.01, 95 % CI: 0.96-1.07 per 5 dB[A]) and stroke (PR 0.97, 95 % CI: 0.92-1.03 per 5 dB[A]). The risks of CVD and hypertension associated with environmental noise were higher among males and in the 50-60 years age group (P for interaction < 0.001). The associations between environmental noise and IHD were stronger in the ≥ 70 age group and among the participants with lower education levels (P for interaction < 0.05). The study fills the gap of knowledge about the associations between environmental noise, estimated using high spatial resolution LUR models, and CVD prevalent risk in LMICs. The evidence would provide significant implications for policy-making in terms of alleviating the surging disease burden of CVD related to environmental noise in LMICs.