Transportation Noise Exposure Research Articles

Long-term exposure to transportation noise in relation to global cognitive decline and cognitive impairment: Results from a Swedish longitudinal cohort

Background and aimsTransportation noise is an environmental exposure with mounting evidence of adverse health effects. Besides the increased risk of cardiovascular and metabolic diseases, recent studies suggest that long-term noise exposure might accelerate cognitive decline in older age. We examined the association between transportation noise and cognitive function in a cohort of older adults. MethodsThe present study is based on 2594 dementia-free participants aged 60 + years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Global cognition score and CIND (cognitive impairment, no dementia) were assessed with a comprehensive neuropsychological battery at baseline and up to 16 years. Residential transportation noise resulting from road traffic, railway, and aircraft were estimated at the most exposed façade and the time-weighted average exposure was assessed. Linear mixed-effect models were used to assess the effect of long-term traffic noise exposure on the rate of change in global cognition score. Hazard ratios (HRs) and 95 % confidence intervals (CIs) of CIND by transportation noise exposure were obtained with Cox proportional hazard models. ResultsGlobal cognition score decreased at an average rate of −0.041 (95 %CI −0.043, −0.039) per year. Aircraft noise was associated with a 0.007 (per 10 dB Lden; 95 %CI −0.012, −0.001) faster annual rate of decline. Global cognition score seems to be not affected by road traffic and railway noise. During the follow-up, 422 (21 %) participants developed CIND. A 10-dB Lden difference in exposure to aircraft and railway noise was associated with a 16 % (HR 1.16, 95 %CI 0.91, 1.49) and 26 % (HR 1.26, 95 %CI 1.01, 1.56) increased hazard of CIND in the multi-pollutant model, respectively. No association was found for road traffic (HR 1.00, 95 %CI 0.83, 1.21). ConclusionsTransportation noise was linked to cognitive impairment and faster cognitive decline among older adults. Future studies are warranted to confirm our results.

Estimates of population highly annoyed from transportation noise in the United States: An unfair share of the burden by race and ethnicity

Transportation is one of the most pervasive sources of community noise. In this study, we used a spatially-resolved model of transportation-related noise with established transportation noise exposure-response functions to estimate the population highly annoyed (HA) due to aviation, road, and railway traffic sources in the United States. Additionally, we employed the use of the Fair Share Ratio to assess race/ethnicity disparities in traffic noise exposures. Our results estimate that in 2020, 7.8 million (2.4%) individuals were highly annoyed by aviation noise, while 5.2 million (1.6%) and 7.9 million (2.4%) people were highly annoyed by rail and roadway noise, respectively, across the US. The Fair Share Ratio revealed that Non-Hispanic Asian, Black, NHPI, and Other, and Hispanic populations were disproportionally highly annoyed by transportation noise nationwide. Notably, Hispanic populations experienced the greatest share of high annoyance from aviation noise (1.69 times their population share). Non-Hispanic Black populations experienced the greatest share of high annoyance from railway noise (1.48 times their population share). Non-Hispanic Asian populations experienced the greatest share of high annoyance from roadway noise (1.51 times their population share). Analyses at the state and Urban Area levels further highlighted varying disparities in transportation noise exposure and annoyance across different race ethnicity groups, but still suggested that Non-Hispanic White populations were less annoyed by all sources of transportation noise compared to non-White populations. Our findings indicate widespread presence of transportation noise annoyance across the US and emphasize the need for targeted source-specific noise mitigation strategies and policies to minimize the disproportionate impact of transportation noise in the US.

Sozialräumliche Unterschiede im Engagement älterer Großstadtbewohner gegen Verkehrslärm? Schlussfolgerungen für eine verteilungs- und verfahrensgerechte Lärmaktionsplanung

Exposure to transportation noise is a highly prevalent health burden in urban areas. Social-spatially unequal distributions of transportation noise exposure can contribute to health inequalities (distributional environmental justice). Noise action planning according to the EU Environmental Noise Directive is the instrument for noise abatement at the local level. In this context, public participation in terms of procedural environmental justice becomes relevant. Socio-spatial indicators used to describe environmental justice mainly deal with the distributional aspect. The question is to what extent both unequal environmental quality on the one hand and unequal participation on the other can be traced by indicators and spatial units typically used in social monitoring at the local level. Using the distance measure index of German social welfare rates and the local voter turnout in 2014, the socio-spatial distribution of factors of objective environmental quality, subjective noise exposure and engagement against transportation noise among older residents in three major cities in the German Ruhr region was examined. In order to address the observed inequalities within noise action planning, distributional and procedural aspects have to be integrated in noise action planning.

Identifying interactions between determinants of intention for civic engagement against transportation noise exposure – a theory-driven classification tree analysis with cross-sectional data from the KORA study in Germany

The European Environmental Noise Directive highlights public participation in the development and review of noise action plans. Considering unequal participation opportunities, determinants of public civic engagement are crucial. We conceptualised these determinants to arise from four components: (1) noise exposure, (2) environmental resources, (3) engagement-specific cognitions, and (4) general cognitions and emotions. We aimed to classify intention for civic engagement in a population-based sample from the German KORA study in the Augsburg region by using Conditional Inference Trees (CIT) with variables attributed to the four components (N = 3,743, 43–92 years). The “engagement-specific cognitions”-CIT showed the highest prevalence of civic engagement intention resulting from interactions between subjective norm (expecting positive feedback from significant others), self-efficacy (having confidence to engage), and knowledge of noise abatement planning (70.6% as compared to the sample average (11.2%)). To promote equitable decision-making, participation might benefit from focusing on residents’ cognitive-behavioural processes.

Vascular Redox Signaling, Endothelial Nitric Oxide Synthase Uncoupling, and Endothelial Dysfunction in the Setting of Transportation Noise Exposure or Chronic Treatment with Organic Nitrates.

Significance: Cardiovascular disease and drug-induced health side effects are frequently associated with-or even caused by-an imbalance between the concentrations of reactive oxygen and nitrogen species (RONS) and antioxidants, respectively, determining the metabolism of these harmful oxidants. Recent Advances: According to the "kindling radical" hypothesis, the initial formation of RONS may further trigger the additional activation of RONS formation under certain pathological conditions. The present review specifically focuses on a dysfunctional, uncoupled endothelial nitric oxide synthase (eNOS) caused by RONS in the setting of transportation noise exposure or chronic treatment with organic nitrates, especially nitroglycerin (GTN). We further describe the various "redox switches" that are proposed to be involved in the uncoupling process of eNOS. Critical Issues: In particular, the oxidative depletion of tetrahydrobiopterin and S-glutathionylation of the eNOS reductase domain are highlighted as major pathways for eNOS uncoupling upon noise exposure or GTN treatment. In addition, oxidative disruption of the eNOS dimer, inhibitory phosphorylation of eNOS at the threonine or tyrosine residues, redox-triggered accumulation of asymmetric dimethylarginine, and l-arginine deficiency are discussed as alternative mechanisms of eNOS uncoupling. Future Directions: The clinical consequences of eNOS dysfunction due to uncoupling on cardiovascular disease are summarized also, providing a template for future clinical studies on endothelial dysfunction caused by pharmacological or environmental risk factors.

The combined effect of air and transportation noise pollution on atherosclerotic inflammation and risk of cardiovascular disease events

BackgroundAir pollution and noise exposures individually associate with major adverse cardiovascular events (MACE) via a mechanism involving arterial inflammation (ArtI); however, their combined impact on ArtI and MACE remains unknown. We tested whether dual (vs. one or neither) exposure associates with greater ArtI and MACE risk and whether MACE risk is mediated via ArtI. MethodsIndividuals (N = 474) without active cancer or known cardiovascular disease with clinical 18F-FDG-PET/CT imaging were followed for 5 years for MACE. ArtI was measured. Average air pollution (particulate matter ≤ 2.5 μm, PM2.5) and transportation noise exposure were determined at individual residences. Higher exposures were defined as noise > 55 dBA (World Health Organization cutoff) and PM2.5 ≥ sample median. ResultsAt baseline, 46%, 46%, and 8% were exposed to high levels of neither, one, or both pollutants; 39 experienced MACE over a median 4.1 years. Exposure to an increasing number of pollutants associated with higher ArtI (standardized β [95% CI: .195 [.052, .339], P = .008) and MACE (HR [95% CI]: 2.897 [1.818–4.615], P < .001). In path analysis, ArtI partially mediated the relationship between pollutant exposures and MACE (P < .05). ConclusionAir pollution and transportation noise exposures contribute incrementally to ArtI and MACE. The mechanism linking dual exposure to MACE involves ArtI.

Suicide and Transportation Noise: A Prospective Cohort Study from Switzerland.

Although plausible from a pathophysiological point of view, robust evidence for effects of transportation noise on mental health remains scarce. Meanwhile, psychiatric diseases are among the most prevalent noncommunicable diseases worldwide, and suicide as a mortality outcome highly connected to mental disorders presents a pressing public health issue. The aim of this study was to investigate the association between source-specific transportation noise, particulate matter (PM) air pollution, residential greenness, and suicide by means of a nationwide cohort study. Road traffic, railway and aircraft noise exposure as well as exposure to air pollution [PM with aerodynamic diameter ()] and greenness [normalized difference vegetation index (NDVI)] were linked to 5.1 million adults (age 15 y and older) in the Swiss National Cohort, accounting for their address history. Mean noise exposure in 5-y periods was calculated. Individuals were followed for up to 15 y (2001-2015). Time-varying Cox regression models were applied to deaths by suicide (excluding assisted suicide). Models included all three noise sources, , and NDVI plus individual and spatial covariates, including socioeconomic status. Effect modification by sex, age, socioeconomic indicators, and degree of urbanization was explored. During the follow-up, there were 11,265 suicide deaths (10.4% poisoning, 33.3% hanging, 28.7% firearms, 14.7% falls). Road traffic and railway noise were associated with total suicides [hazard ratios: 1.040; 95% confidence interval (CI): 1.015, 1.065; and 1.022 (95% CI: 1.004, 1.041) per 10 dB day-evening-night level (Lden)], whereas for aircraft noise, a risk increase starting from 50 dB was masked by an inverse association in the very low exposure range (30-40 dB). Associations were stronger for females than males. The results were robust to adjustment for residential greenness and air pollution. In this longitudinal, nationwide cohort study, we report a robust association between exposure to road traffic and railway noise and risk of death by suicide after adjusting for exposure to air pollution and greenness. These findings add to the growing body of evidence that mental health disorders may be related to chronic transportation noise exposure. https://doi.org/10.1289/EHP11587.

Environmental quality or behavioural cognitions? Identifying variables that can be used to classify intended civic engagement against transportation noise exposure

The European Environmental Noise Directive opens the door for the public to participate in the development and review of noise action plans. Regarding health inequities related to environmental noise exposure, we aimed to identify determinants that influence residents' civic engagement against transportation noise exposure. We defined four variable groups representing either environmental quality with indicators of (1) noise exposure and (2) environmental resources or behavioural cognitions with indicators related to (3) civic engagement and (4) generalised emotions and cognitions. We used data collected from 3,743 participants in the population-based KORA study in the Augsburg region, Germany, and employed Conditional Inference Trees (CIT) to identify variable sets within these four groups that are most likely to classify civic engagement intentions. A final CIT model encompassed all variables. Participants' social characteristics were included in each of our CIT models. Results suggest interactions between environmental quality (related to sound/atmosphere in the sleeping room) and income and between income and emotions (positive affectivity) with respect to engagement intentions. When considered simultaneously, engagement-specific cognitions appeared as more relevant for engagement intentions than environmental quality. This finding indicates that noise action planning should take behavioural cognitions into account when designing participation processes.

Reflections on burden of disease and health impact assessment methods for noise

Burden of Disease (BoD) assesses the noise impact on health at a given time and in a given population, whereas Health Impact Assessments (HIA) are conducted in the frame of decision-making to evaluate health effects of a policy, programme or project. In a 2020 report, the European Environmental Agency estimates transportation noise exposure in Europe annually results in 22 million highly annoyed, 6.5 million highly sleep disturbed, 48,000 cases of ischemic heart diseases and 12,000 deaths, and 12,400 children with cognitive impairments. These are based on END exposure assessment and exposure-response functions from the WHO noise guidelines 2018. Many more regional or national HIA and BoD studies have been conducted, and common methods across future assessments for consistent communication are needed. Given the rapid developments in noise research, current BoD and HIA are also partly outdated. Critical methodological issues will be discussed using national and regional examples with a focus on Switzerland. This includes the selection of noise sources, relevant health outcomes and corresponding exposure-response functions. Derivation of the lowest effect noise threshold, potential double-counting, and communication of results are also discussed with the aim toward a common understanding for the conduct of future BoD and HIA.

Dose-response association between transportation noise exposure and type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies.

To examine the longitudinal association between transportation noise exposure (road traffic, aircraft, and railway noise) and T2D in a meta-analysis. We systematically searched PubMed, Embase, Scopus, Cochrane, and Web of Science published up to February 2022. The GRADE approach was used to evaluate the study quality, and the pooled effect estimate was calculated by the fixed-effects model or the random-effects model. We included 10 prospective studies with a total of 4,994,171 participants and 417,332 T2D cases in the meta-analysis. According to the Navigation guide, 8 studies out of 10 were rated as having a probably high or high risk of bias. For road noise, the pooled relative risk (RR) per 10dB higher Lden for developing T2D was 1.06 (95% CI:1.03, 1.09) with high heterogeneity (I2 =90.1%, p<0.001). Similar associations were also observed in aircraft and railway noise: the pooled RR were separately were: 1.01 (1.00, 1.01) and 1.02 (1.01, 1.03) separately. A 'dose-response' analysis found a similar linear association between road noise exposure and the risk of T2D. An overall 6% increase in the risk of T2D per 10dB increase in road exposure was observed. Further studies are needed to confirm our findings, especially for aircraft and railway noise, and to identify the mechanisms involved.

Transportation noise exposure, insulin resistance and diabetes: what is the role of sleep?

Transportation noise exposure, insulin resistance and diabetes: what is the role of sleep?

Suicide and transportation noise: a prospective cohort study from Switzerland

Background: Evidence for effects of transportation noise on mental health remains scarce, mainly due to a lack of high quality studies. Meanwhile, psychiatric diseases are among the most prevalent non-communicable diseases worldwide, and suicide as a mortality outcome presents a pressing public health issue. The aim of this study is to investigate the association between transportation noise and suicide, while adjusting for air pollution. Methods: Road traffic, railway and aircraft noise exposure as well as PM2.5 exposure were linked to 5.1 million participants 15 years or older in the Swiss National Cohort, accounting for their address history. Mean noise exposure in 5-year periods was calculated. Individuals were followed for up to 15-years (2001-2015). Time-varying Cox regression models were applied to total suicides and cause-specific suicide deaths. Models included all three noise sources, PM2.5 plus individual and spatial covariates including socio-economic status. Effect modification by sex was also explored. Results: During the follow-up, there were 11,265 suicide deaths. Road traffic and railway noise were associated with total suicides (Hazard ratio: 1.039 [95% CI: 1.015-1.064] and 1.022 [1.004-1.041] per 10dB Lden, respectively ), while no significant association was found for aircraft noise. Associations were stronger for females than males. The pattern was robust across all outcomes, with the strongest association seen in non-violent suicides (poisoning: HR 1.122 [1.042-1.209] per 10dB Lden road traffic noise). No robust association was observed for PM2.5, whether adjusted for noise or separately. Conclusion: In this longitudinal, nationwide cohort study, we report a robust association between exposure to road traffic and railway noise and an increased risk for death by suicide. These findings add to the growing body of evidence that mental health disorders may be related to transportation noise exposure. Keywords : road traffic, railway, aircraft, Lden, air pollution, mental health

Transportation noise exposure and cardiovascular mortality: 15-years of follow-up in a nationwide prospective cohort in Switzerland.

Death from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source. Road traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM2.5, adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group. During a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024-1.034), 1.013 (1.010-1.017), and 1.003 (0.996-1.010) per 10dB Lden, respectively. Associations for MI mortality were a respective 1.043 (1.029-1.058), 1.020 (1.010-1.030) and 1.040 (1.020-1.060) per 10dB Lden. Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40dB Lden for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females. Independent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits.

Consider the Source: Noise-Stroke Association Varies by Transportation Type.

Consider the Source: Noise-Stroke Association Varies by Transportation Type.

Transportation Noise Exposure, Insulin Resistance and Diabetes: The Role of Sleep and Neighborhood Socioeconomic Status in San Diego County

Transportation Noise Exposure, Insulin Resistance and Diabetes: The Role of Sleep and Neighborhood Socioeconomic Status in San Diego County

Invited Perspective: Diabetes and Road Traffic Noise at the Most and Least Exposed Façade.

Invited Perspective: Diabetes and Road Traffic Noise at the Most and Least Exposed Façade.

Considering ‘non-acoustic factors’ as social and environmental determinants of health equity and environmental justice. Reflections on research and fields of action towards a vision for environmental noise policies

Despite being an overall objective of European policies, health equity and environmental justice have not yet been systematically implemented in environmental policies. Taking control over one’s environment as an element of health equity, we consider intractable exposure to transportation noise as a highly relevant policy field. The European Environmental Noise Directive is designed as a sectoral policy dealing with one environmental health determinant (noise) and drawing on the Global Burden of Disease framework, whereas health equity demands an investigation of the manifold variations in the population by combining adverse noise exposure with salutogenetic (psycho-)social and environmental resources. Such resources or the lack thereof have been referred to as ‘non-acoustic factors’ in noise- and soundscape-related research and can presumably account for vulnerability to transportation noise exposure caused by social and environmental determinants. Thus, we aim to link the current discourse on ‘non-acoustic factors’ with health equity driven by the need to go beyond average exposure–response-relations. After summarising challenges of environmental noise-related health impact assessment from a health equity perspective, we focus on residents’ control – both procedurally and environmentally – to illustrate how social and environmental determinants can cause vulnerability. We advocate to consider ‘non-acoustic factors’ as leverage to promote health equity and environmental justice through three fields of potential action: (1) developing a theoretical and methodological groundwork and multi/interdisciplinary training of students and professionals, (2) introducing comprehensible information and inclusive participation methods, and (3) creating supportive institutional frames and governance modes. The contents of this paper were derived from a workshop held at the University of Bremen in September 2020.

A neurobiological link between transportation noise exposure and metabolic disease in humans

BackgroundChronic transportation noise exposure associates with cardiovascular events through a link involving heightened stress-associated neurobiological activity (as amygdalar metabolic activity, AmygA) on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT). Increased AmygA also associates with greater visceral adipose tissue (VAT) and type 2 diabetes mellitus (DM). While relationships between noise exposure and VAT and DM have been reported, the underlying mechanisms remain incompletely understood. We tested whether: (1) transportation noise exposure associates with greater (a) baseline and gains in VAT and (b) DM risk, and (2) heightened AmygA partially mediates the link between noise exposure and these metabolic diseases. MethodsVAT was measured in a retrospective cohort (N = 403) who underwent clinical 18F-FDG-PET/CT. AmygA was measured in those with brain imaging (N = 238). Follow-up VAT was remeasured on available imaging (N = 67). Among individuals (N = 224) without baseline DM, incident DM was adjudicated over 2 years from clinical records. Noise (24-h average) was modeled at each individual’s home address. Linear regression, survival, and mediation analyses were employed. ResultsHigher noise exposure (upper tertile vs. others) associated with greater: baseline VAT (standardized β [95% confidence interval (CI)]= 0.230 [0.021, 0.438], p = 0.031), gains in VAT (0.686 [0.185, 1.187], p = 0.008 adjusted for baseline VAT), and DM (hazard ratio [95% CI]=2.429 [1.031, 5.719], p = 0.042). The paths of: ↑noise exposure→↑AmygA→↑baseline VAT and ↑noise exposure→↑AmygA→↑subsequent DM were significant (p < 0.05). ConclusionsIncreased transportation noise exposure associates with greater VAT and DM. This relationship is partially mediated by stress-associated neurobiological activity. These findings suggest altered neurobiology contributes to noise exposure’s link to metabolic diseases.

Transportation noise exposure and cardiovascular mortality: a 15-year analysis in Switzerland

Background: Transportation noise from road, rail and air traffic can be detrimental to health and wellbeing. Previous studies, including our own, have shown death from specific cardiovascular diseases (CVD) to be associated with these exposures. Now, with double the follow-up, integrated address history and transportation noise exposure data for multiple years corresponding to census decades, we conducted an extended analysis of the Swiss National Cohort. Methods: Mean noise exposure in 5-year periods was calculated, and three virtual sub-cohorts were defined (2000-2005, etc.) in addition to the full cohort (2000-2015). Multi-pollutant (Lden_road, Lden_rail, Lden_air), time dependent Cox proportional hazards models were applied to 3.8 mil adults (30-100 years old at 2000; age as timescale) and adjusted for sex, civil status, education, mother tongue, nationality, neighborhood socio-economic position and NO2 exposure. Results: During the 15-year follow-up, there were 249,000 CVD and 30,500 myocardial infarction deaths. In the full cohort, the relative risk for myocardial infarction mortality significantly increased by 4.1% [95% confidence interval: 2.6−5.6], 2.0% [0.9−3.1] and 3.2% [1.5−5.0] per 10 dB road traffic, railway and aircraft noise, respectively. CVD mortality was also significantly associated with road traffic noise (2.7% [2.2−3.2]) and railway noise (1.6% [1.2−2.0]) per 10 dB increase. Relative risks were remarkably consistent with our previous analyses with follow-up until 2008, and rather similar across the three virtual sub-cohorts indicating an absence of time trends for these associations. Conclusions: Cardiovascular effects of transportation noise may be modified by many factors such as building characteristics, window opening habits during the night and other lifestyle factors. For this reason, representative local data can be highly valuable for informing national noise limits aimed at protecting public health.

Incidence of depression in relation to transportation noise exposure and noise annoyance in the SAPALDIA study

Prospective evidence on the risk of depression in relation to transportation noise exposure and noise annoyance is limited and mixed. We aimed to investigate the associations of long-term exposure to source-specific transportation noise and noise annoyance with incidence of depression in the SAPALDIA (Swiss cohort study on air pollution and lung and heart diseases in adults) cohort.We investigated 4,581 SAPALDIA participants without depression in the year 2001/2002. Corresponding one-year mean road, railway and aircraft day-evening-night noise (Lden) was calculated at the most exposed façade of the participants’ residential floors, and transportation noise annoyance was assessed on an 11-point scale. Incident cases of depression were identified in 2010/2011, and comprised participants reporting physician diagnosis, intake of antidepressant medication or having a short form-36 mental health score < 50. We used robust Poisson regressions to estimate the mutually adjusted relative risks (RR) and 95% confidence intervals (CI) of depression, independent of traffic-related air pollution and other potential confounders.Incidence of depression was 11 cases per 1,000 person-years. In single exposure models, we observed positive but in part, statistically non-significant associations (per 10 dB) of road traffic Lden [RR: 1.06 (0.93, 1.22)] and aircraft Lden [RR: 1.19 (0.93, 1.53)], and (per 1-point difference) of noise annoyance [RR: 1.05 (1.02, 1.08)] with depression risk. In multi-exposure model, noise annoyance effect remained unchanged, with weaker effects of road traffic Lden [(RR: 1.02 (0.89, 1.17)] and aircraft Lden [(RR: 1.17 (0.90, 1.50)]. However, there were statistically significant indirect effects of road traffic Lden [(β: 0.02 (0.01, 0.03)] and aircraft Lden [β: 0.01 (0.002, 0.02)] via noise annoyance. There were no associations with railway Lden in the single and multi-exposure models [(RRboth models: 0.88 (0.75, 1.03)]. We made similar findings among 2,885 non-movers, where the effect modification and cumulative risks were more distinct. Noise annoyance effect in non-movers was stronger among the insufficiently active (RR: 1.09; 95%CI: 1.02, 1.17; pinteraction = 0.07) and those with daytime sleepiness [RR: 1.07 (1.02, 1.12); pinteraction = 0.008]. Cumulative risks of Lden in non-movers showed additive tendencies for the linear cumulative risk [(RRper 10dB of combined sources: 1.31 (0.90, 1.91)] and the categorical cumulative risk [(RRtriple- vs. zero-source ≥45 dB: 2.29 (1.02, 5.14)], and remained stable to noise annoyance.Transportation noise level and noise annoyance may jointly and independently influence the risk of depression. Combined long-term exposures to noise level seems to be most detrimental, largely acting via annoyance. The moderation of noise annoyance effect by daytime sleepiness and physical activity further contribute to clarifying the involved mechanisms. More evidence is needed to confirm these findings for effective public health control of depression and noise exposure burden.