Abstract WP144: Association between transportation noise exposure and post-stroke outcomes: a population-based study

Background: Transportation noise is a prevalent environmental exposure associated with higher stroke risk. But its impact on post-stroke outcomes in the US population has not been examined. We investigated the association between transportation noise exposure and stroke severity, recurrence, and mortality in a population-based stroke study. Methods: We used data from the Brain Attack Surveillance in Corpus Christi Project (2018-2023) in patients with acute incident ischemic stroke. Recurrence was ascertained through medical record review. Mortality was ascertained by active surveillance of all hospital deaths, and linkage with the Texas Department of State Health Services death certificate database. We obtained transportation noise data from the US Department of Transportation (2018) and defined exposure as the maximum A-weighted noise level within a 100-meter radius of the patient’s home at the time of their stroke. Individual-level covariates included age, sex, ethnicity, insurance status, education, smoking, and alcohol use. Tract-level covariates were mapped using 2020 US Census tract boundaries and included median household income, PM 2.5 , nitrogen dioxide, and average population. We used Cox proportional hazards regression models to measure the associations between transportation noise and stroke recurrence and all-cause mortality, with follow-up time starting at the incident stroke. We used linear regressions to measure the association between transportation noise and stroke severity, assessed as log-transformed NIHSS scores plus one. Results: Out of 1,894 participants (mean age 68.3 years, Table 1), 122 had a recurrent stroke, and 541 died over a median 2 years of follow-up. Median transportation noise exposure was of 45.5 (IQR=0.0, 56.4) decibels. Patients exposed to transportation noise at the 75 th percentile versus the 25 th percentile had a 39% higher rate of recurrence (HR=1.39, 95% CI=0.98, 1.97; Table 2) in the unadjusted model, which attenuated to 32% (HR=1.32, 95% CI=0.93, 1.87) after covariate adjustment. Transportation noise was not associated with mortality or stroke severity. Conclusion: Transportation noise exposure is associated with an elevated rate of stroke recurrence but not mortality. These findings demonstrate the possible impact of transportation noise on stroke prognosis and underscore the importance of further well-powered research exploring the impact of this prevalent environmental risk factor on stroke risk and outcomes.