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Changes in Traffic Exposure and the Risk of Incident Myocardial Infarction and All-Cause Mortality

Hart, Jaime E.a,b,c; Rimm, Eric B.b,d; Rexrode, Kathryn M.e; Laden, Francinea,b,c

doi: 10.1097/EDE.0b013e31829d5dae

Background: Traffic-related exposures, such as air pollution and noise, have been associated with increased cardiovascular morbidity and mortality. Few studies, however, have been able to examine the effects of changes in exposure on changes in risk. Our objective was to explore the associations of changes in traffic exposure with changes in risk between 1990 and 2008 in the Nurses’ Health Study.

Methods: Incident myocardial infarction (MI) and all-cause mortality were prospectively identified. As a proxy for traffic exposure, we calculated residential distance to roads at all residential addresses 1986–2006 and considered addresses to be “close” or “far” based on distance and road type. To examine the effect of changes in exposure, each consecutive pair of addresses was categorized as: (1) consistently close, (2) consistently far, (3) change from close to far, and (4) change from far to close. We also examined the change in NO2 levels between address pairs.

Results: In time-varying Cox proportional hazards models adjusted for a variety of risk factors, women living at residences consistently close to traffic were at a higher risk of an incident MI (hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 1.01–1.22) and a higher risk of all-cause mortality (1.05; 1.00–1.10), compared with those consistently far. The highest risks were seen among women who moved from being far from traffic to close (incident MI: HR = 1.50 [95% CI = 1.11–2.03]; all-cause mortality: HR = 1.17 [95% CI = 1.00–1.37]). Each 1 ppb increase in NO2 compared with the previous address was associated with a HR = 1.22 for incident MI (95% CI = 0.99–1.50) and 1.03 for all-cause mortality (95% CI = 0.92–1.15).

Conclusions: Our results suggest that changes in traffic exposure (measured as roadway proximity or change in NO2 levels) are associated with changes in risk of MI and all-cause mortality.

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From the aDepartment of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; bDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; cExposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA; dDepartment of Nutrition, Harvard School of Public Health, Boston, MA; and eDivision of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

Supported, in part, by National Institute of Health grants R01 ES017017, P01 CA87969, and R01 HL034594.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Jaime E. Hart, Channing Division of Network Medicine, 181 Longwood Ave, Boston, MA 02115. E-mail:

Received June 7, 2012

Accepted March 11, 2013

© 2013 by Lippincott Williams & Wilkins, Inc