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Ohanyan H, van de Wiel M, Portengen L, Wagtendonk A, den Braver NR, de Jong TR, Verschuren M, van den Hurk K, Stronks K, Moll van Charante E, van Schoor NM, Stehouwer CDA, Wesselius A, Koster A, Ten Have M, Penninx BWJH, van Wier MF, Motoc I, Oldehinkel AJ, Willemsen G, Boomsma DI, Beenackers MA, Huss A, van Boxtel M, Hoek G, Beulens JWJ, Vermeulen R, Lakerveld J. Exposome-Wide Association Study of Body Mass Index Using a Novel Meta-Analytical Approach for Random Forest Models. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:67007. [PMID: 38889167 DOI: 10.1289/ehp13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Overweight and obesity impose a considerable individual and social burden, and the urban environments might encompass factors that contribute to obesity. Nevertheless, there is a scarcity of research that takes into account the simultaneous interaction of multiple environmental factors. OBJECTIVES Our objective was to perform an exposome-wide association study of body mass index (BMI) in a multicohort setting of 15 studies. METHODS Studies were affiliated with the Dutch Geoscience and Health Cohort Consortium (GECCO), had different population sizes (688-141,825), and covered the entire Netherlands. Ten studies contained general population samples, others focused on specific populations including people with diabetes or impaired hearing. BMI was calculated from self-reported or measured height and weight. Associations with 69 residential neighborhood environmental factors (air pollution, noise, temperature, neighborhood socioeconomic and demographic factors, food environment, drivability, and walkability) were explored. Random forest (RF) regression addressed potential nonlinear and nonadditive associations. In the absence of formal methods for multimodel inference for RF, a rank aggregation-based meta-analytic strategy was used to summarize the results across the studies. RESULTS Six exposures were associated with BMI: five indicating neighborhood economic or social environments (average home values, percentage of high-income residents, average income, livability score, share of single residents) and one indicating the physical activity environment (walkability in 5 -km buffer area). Living in high-income neighborhoods and neighborhoods with higher livability scores was associated with lower BMI. Nonlinear associations were observed with neighborhood home values in all studies. Lower neighborhood home values were associated with higher BMI scores but only for values up to € 300,000 . The directions of associations were less consistent for walkability and share of single residents. DISCUSSION Rank aggregation made it possible to flexibly combine the results from various studies, although between-study heterogeneity could not be estimated quantitatively based on RF models. Neighborhood social, economic, and physical environments had the strongest associations with BMI. https://doi.org/10.1289/EHP13393.
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Affiliation(s)
- Haykanush Ohanyan
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Mark van de Wiel
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Alfred Wagtendonk
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | | | - Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Katja van den Hurk
- Donor Medicine Research - Donor Studies, Sanquin Research, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eric Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anke Wesselius
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mood, Anxiety, Psychosis, Sleep & Stress Program, Mental Health Program and Amsterdam Neuroscience, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marieke F van Wier
- Department of Otolaryngology-Head and Neck Surgery, section Ear and Hearing, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Irina Motoc
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Albertine J Oldehinkel
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mariëlle A Beenackers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
- Lifelines Cohort & Biobank, Roden, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Lifelines Cohort & Biobank, Roden, the Netherlands
| | - Jeroen Lakerveld
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
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Veber T, Pyko A, Carlsen HK, Holm M, Gislason T, Janson C, Johannessen A, Sommar JN, Modig L, Lindberg E, Schlünssen V, Toompere K, Orru H. Traffic noise in the bedroom in association with markers of obesity: a cross-sectional study and mediation analysis of the respiratory health in Northern Europe cohort. BMC Public Health 2023; 23:1246. [PMID: 37370100 DOI: 10.1186/s12889-023-16128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Previous research suggests an association between road traffic noise and obesity, but current evidence is inconclusive. The aim of this study was to assess the association between nocturnal noise exposure and markers of obesity and to assess whether sleep disturbance might be a mediator in this association. METHODS We applied data from the Respiratory Health in Northern Europe (RHINE) cohort. We used self-measured waist circumference (WC) and body mass index (BMI) as outcome values. Noise exposure was assessed as perceived traffic noise in the bedroom and/or the bedroom window's location towards the street. We applied adjusted linear, and logistic regression models, evaluated effect modifications and conducted mediation analysis. RESULTS Based on fully adjusted models we found that women, who reported very high traffic noise levels in bedroom, had 1.30 (95% CI 0.24-2.37) kg/m2 higher BMI and 3.30 (95% CI 0.39-6.20) cm higher WC compared to women, who reported no traffic noise in the bedroom. Women who reported higher exposure to road traffic noise had statistically significant higher odds of being overweight and have abdominal obesity with OR varying from 1.15 to 1.26 compared to women, who reported no traffic noise in the bedroom. For men, the associations were rather opposite, although mostly statistically insignificant. Furthermore, men, who reported much or very much traffic noise in the bedroom, had a statistically significantly lower risk of abdominal obesity. Sleep disturbance fully or partially mediated the association between noise in bedroom and obesity markers among women. CONCLUSION Our results suggest that self-reported traffic noise in the bedroom may be associated to being overweight or obese trough sleep disturbance among women, but associations were inconclusive among men.
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Affiliation(s)
- Triin Veber
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Andrei Pyko
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Hanne Krage Carlsen
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Johan Nilsson Sommar
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Modig
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Lindberg
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Vivi Schlünssen
- Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Karolin Toompere
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Dzhambov AM, Dimitrova V, Germanova N, Burov A, Brezov D, Hlebarov I, Dimitrova R. Joint associations and pathways from greenspace, traffic-related air pollution, and noise to poor self-rated general health: A population-based study in Sofia, Bulgaria. ENVIRONMENTAL RESEARCH 2023; 231:116087. [PMID: 37169139 DOI: 10.1016/j.envres.2023.116087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Little is still known of how multiple urban exposures interact as health determinants. This study investigated various ways in which greenspace, traffic-related air pollution, and noise could operate together, influencing general health status. METHODS In 2022, a cross-sectional population-based survey was conducted in Sofia, Bulgaria. Included were 917 long-term adult residents who completed questionnaires on poor self-rated health (PSRH), total time spent in physical activity (PA), home garden presence, time spent in urban greenspace and nature, and sociodemographics. Residential greenspace was operationalized using the normalized difference vegetation index (NDVI), tree cover density, number of trees, and access to local greenspace and parks. Nitrogen dioxide (NO2) was modeled for the study area. Road traffic, railway, and aircraft day-evening-night sound levels (Lden) were extracted from EU noise maps. Area-level income and urbanicity were considered. Analyses included multivariate ordinal regressions, interactions, and structural equation modeling (SEM). RESULTS Associations with PSRH were per 0.10 NDVI 300 m: OR = 0.65 (0.42-1.01), home garden: OR = 0.72 (0.49-1.07), per 5 μg/m3 NO2: OR = 1.57 (1.00-2.48), per 5 dB(A) Lden road traffic: OR = 1.06 (0.91-1.23), railway: OR = 1.11 (1.03-1.20), and aircraft: OR = 1.22 (1.11-1.34). Spending >30 min/week in nature related to better health. In multi-exposure models, only associations with aircraft and railway Lden persisted. People with lower education and financial difficulties or living in poorer districts experienced some exposures stronger. In SEM, time spent in nature and PA mediated the effect of greenspace. CONCLUSIONS Greenspace was associated with better general health, with time spent in nature and PA emerging as intermediate pathways. NO2, railway, and aircraft noise were associated with poorer general health. These results could inform decision-makers, urban planners, and civil society organizations facing urban development problems. Mitigation and abatement policies and measures should target socioeconomically disadvantaged citizens.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Bulgaria; Research Group "Health and Quality of Life in a Green and Sustainable Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
| | - Veronika Dimitrova
- Department of Sociology, Faculty of Philosophy, Sofia University "St. Kliment Ohridski", Bulgaria
| | - Nevena Germanova
- Department of Spatial and Strategic Planning of Sofia Municipality - Sofiaplan, Bulgaria
| | - Angel Burov
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Urban Planning, Faculty of Architecture, University of Architecture, Civil Engineering and Geodesy, Bulgaria
| | - Danail Brezov
- Department of Mathematics, Faculty of Transportation Engineering, University of Architecture, Civil Engineering and Geodesy, Bulgaria
| | - Ivaylo Hlebarov
- Clean Air Team, Environmental Association Za Zemiata, Bulgaria
| | - Reneta Dimitrova
- Department of Meteorology and Geophysics, Faculty of Physics, Sofia University "St. Kliment Ohridski", Bulgaria; National Institute of Geophysics, Geodesy and Geography, Bulgarian Academy of Sciences, Bulgaria
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Roswall N, Thacher JD, Ögren M, Pyko A, Åkesson A, Oudin A, Tjønneland A, Rosengren A, Poulsen AH, Eriksson C, Segersson D, Rizzuto D, Helte E, Andersson EM, Aasvang GM, Gudjonsdottir H, Khan J, Selander J, Christensen JH, Brandt J, Leander K, Mattisson K, Eneroth K, Stucki L, Barregard L, Stockfelt L, Albin M, Simonsen MK, Spanne M, Jousilahti P, Tiittanen P, Molnàr P, Ljungman PLS, Yli-Tuomi T, Cole-Hunter T, Lanki T, Hvidtfeldt UA, Lim YH, Andersen ZJ, Pershagen G, Sørensen M. Long-term exposure to traffic noise and risk of incident colon cancer: A pooled study of eleven Nordic cohorts. ENVIRONMENTAL RESEARCH 2023; 224:115454. [PMID: 36764429 DOI: 10.1016/j.envres.2023.115454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Background Colon cancer incidence is rising globally, and factors pertaining to urbanization have been proposed involved in this development. Traffic noise may increase colon cancer risk by causing sleep disturbance and stress, thereby inducing known colon cancer risk-factors, e.g. obesity, diabetes, physical inactivity, and alcohol consumption, but few studies have examined this. Objectives The objective of this study was to investigate the association between traffic noise and colon cancer (all, proximal, distal) in a pooled population of 11 Nordic cohorts, totaling 155,203 persons. Methods We identified residential address history and estimated road, railway, and aircraft noise, as well as air pollution, for all addresses, using similar exposure models across cohorts. Colon cancer cases were identified through national registries. We analyzed data using Cox Proportional Hazards Models, adjusting main models for harmonized sociodemographic and lifestyle data. Results During follow-up (median 18.8 years), 2757 colon cancer cases developed. We found a hazard ratio (HR) of 1.05 (95% confidence interval (CI): 0.99-1.10) per 10-dB higher 5-year mean time-weighted road traffic noise. In sub-type analyses, the association seemed confined to distal colon cancer: HR 1.06 (95% CI: 0.98-1.14). Railway and aircraft noise was not associated with colon cancer, albeit there was some indication in sub-type analyses that railway noise may also be associated with distal colon cancer. In interaction-analyses, the association between road traffic noise and colon cancer was strongest among obese persons and those with high NO2-exposure. Discussion A prominent study strength is the large population with harmonized data across eleven cohorts, and the complete address-history during follow-up. However, each cohort estimated noise independently, and only at the most exposed façade, which may introduce exposure misclassification. Despite this, the results of this pooled study suggest that traffic noise may be a risk factor for colon cancer, especially of distal origin.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Jesse D Thacher
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark; Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Mikael Ögren
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Andrei Pyko
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Division of Sustainable Health, Umeå University, Sweden
| | - Anne Tjønneland
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Aslak H Poulsen
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Charlotta Eriksson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - David Segersson
- Swedish Meteorological and Hydrological Institute, Norrköping, Sweden
| | - Debora Rizzuto
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Emilie Helte
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunn Marit Aasvang
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Hrafnhildur Gudjonsdottir
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Jenny Selander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Lara Stucki
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leo Stockfelt
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Albin
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Mette K Simonsen
- Department of Neurology and the Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Mårten Spanne
- Environment Department, City of Malmö, Malmö, Sweden
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Tiittanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Peter Molnàr
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Tarja Yli-Tuomi
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Thomas Cole-Hunter
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Timo Lanki
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ulla A Hvidtfeldt
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Mette Sørensen
- Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark; Department of Natural Science and Environment, Roskilde University, Denmark.
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