Association Between Transportation Noise Exposure and Poststroke Outcomes: Population-Based Brain Attack Surveillance in Corpus Christi Project.

BACKGROUND: Transportation noise remains understudied as a potential risk factor for poststroke outcomes in the United States. METHODS: We conducted a prospective cohort study in the Brain Attack Surveillance in Corpus Christi Project (2016-2023) among patients with acute incident ischemic stroke. Transportation noise exposure was derived from US Department of Transportation data (2016, 2018) and defined as the maximum area-weighted noise level within a 100-m buffer of the residential address. Outcomes included initial stroke severity measured by the National Institutes of Health Stroke Scale, stroke recurrence, and all-cause mortality. Linear regression was used to evaluate stroke severity, and Cox proportional hazards models were used for recurrence and mortality. Estimates were scaled to the interquartile range (IQR) of noise exposure to compare high (75th percentile) versus low (25th percentile) exposure. RESULTS: Among 2441 patients, median National Institutes of Health Stroke Scale score was 3.0 (IQR, 1.0-7.0). During follow-up, 176 patients (7.2%) experienced a recurrent stroke and 818 (33.5%) died. Median follow-up was 2.2 years (IQR, 0.7-4.3) for stroke recurrence and 2.5 years (IQR, 0.8-4.6) for mortality. Median transportation noise was 45.5 (IQR, 0.0-56.5) decibels. Higher transportation noise was not associated with stroke severity (-5% [95% CI, -12% 2%]; P=0.14) and mortality (hazard ratio to [HR], 1.08 [95% CI, to 0.941.24]; P=0.26) but was associated with a higher rate of stroke recurrence (HR, 1.36 [95% CI, 1.01 to 1.82]; P=0.04) after adjustments. CONCLUSIONS: Transportation noise may be an environmental risk factor for stroke recurrence, underscoring the need for policies addressing noise exposure.