Urban environment, health, and equity: A population-based study of air pollution and traffic noise

Abstract Background Urban residents are often exposed to hazardous environmental factors. Yet, few studies have mapped inequities in population exposure and associated well-being effects. The aim of this study was to analyse environmental health equity, self-reported symptoms and annoyances, in relation to long-term residential exposure to air pollution and road traffic noise. Methods Our analyses were based on a population sample from the national environmental health survey 2023, including 46,282 adults residing in Stockholm County. To analyse equity in exposure to air pollution (PM2.5, PM10 and NO2) and road traffic noise, we used descriptive statistics stratified by income, education, foreign origin and housing type, respectively. We used WHO cut-offs or medians to dichotomise exposures. In logistic regression models, we estimated odds ratios (OR) and 95% confidence intervals (95% CI) to identify preliminary associations with general and respiratory health outcomes, adjusting for socioeconomic factors. Results The median level of air pollution was 4.47 µg/m³ for PM2.5 and for noise 56 dB Lden. Individuals in apartment buildings, with low income, of foreign origin - but high education - seemed generally more exposed to air pollution and noise than their counterparts. Logistic regressions showed significant associations between all air pollutants and perceived poor outdoor air quality (OR from 2.60 for PM2.5 to 4.38 for NO2) and good general health (OR from 1.12 for NO2 to 1.15 for PM2.5). Strong associations were observed for noise, for instance with annoyance (OR 4.62, 95% CI 4.09-5.25) and sleep disturbance (OR 2.17, 95% CI 1.99-2.35). Conclusions This study highlights patterns of environmental inequities. We observed negative health impacts despite relatively low levels air pollution and noise in European comparison, suggesting the necessity of inclusive and multifaceted policies for sustainable urban planning and public health, also in Nordic cities. Key messages • Inequities in environmental health are apparent between socioeconomic groups in Stockholm. Inclusive policies are needed to safeguard equitable urban health. • We observed negative health impacts despite relatively low levels air pollution and noise in European comparison, suggesting the importance of sustainable urban planning, also in Nordic cities.