Air pollutants, temperature, and road traffic noise: their impact on chronic kidney disease incidence in older individuals in Taiwan.

Limited research has examined the relationships of co-exposure to air pollutants, temperature, and road traffic noise with chronic kidney disease (CKD) incidence and the interaction between PM2.5 and temperature. To address this gap, the present study explored these associations and interactions in Taiwan. A cohort of 3041 older individuals (aged ≥55 years) was recruited in 2009 and followed until 2019. Land use regression (LUR) models were applied to estimate annual exposure levels of air pollutants (PM2.5, NO2, CO, SO2, and O3), temperature, and 24-h A-weighted equivalent sound pressure levels (LAeq,24). We performed Cox regression models to evaluate the associations between exposure to environmental pollutants and CKD incidence. In single-exposure models, an interquartile-range increase in PM2.5 (7.80 μg/m3) and temperature (2.32 °C) was significantly associated with elevated CKD risk (hazard ratio [HR] = 1.14, 95 % confidence interval [CI]: 1.04-1.25; HR = 1.10, 95 %CI: 1.02-1.20), whereas other exposure variables did not present significant relationships. In multiple-exposure models, PM2.5 remained significantly associated with CKD incidence (HR = 1.13, 95 % CI: 1.03-1.25). A synergistic association was observed between high PM2.5 (≥34.22 μg/m3) and high temperature (≥25.71 °C) (Rothman's synergy index: 3.18, 95 % CI: 2.20-4.60). Additionally, elevated CKD risks associated with PM2.5 were more pronounced in females, individuals aged ≥65 years, and individuals with diabetes. These findings underscore the need for regulatory measures to mitigate PM2.5 exposure and mitigate CKD risk in vulnerable populations, particularly older adults and individuals with diabetes.