Association of Outdoor Residential Noise Exposure with Early Childhood Neurodevelopment among Preschoolers in Shanghai, China

Developmental delays represent a significant public health issue among preschoolers. Previous research has linked noise to emotional or behavioral problems in children; however, the association between noise and developmental delays remains unclear. To examine this association, a total of 12,130 children aged 3 to 5.5 years were included from 226 kindergartens in Shanghai, China. Neurodevelopment was assessed using the Chinese version of the Ages & Stages Questionnaires-Third Edition, and individual residential noise exposure (LAeq, 40 min) was estimated using a land-use regression model. Higher noise exposure was associated with lower performance in communication, motor, and problem-solving domains. Specifically, each interquartile range [4 dB(A)] increase in noise exposure was significantly associated with a decrease in gross motor scores (0.25, 95% CI, 0.04-0.47) and an increase in the suspected developmental delay (SDD) odds (OR = 1.08; 95% CI, 1.01-1.15) and domain-specific delays, particularly in communication (OR = 1.13; 95% CI, 1.01-1.27) and gross motor (OR = 1.11; 95% CI, 1.03-1.19). Stratified analyses showed higher estimates of ORs for SDD associated with noise exposure in boys and those who were delivered by cesarean section, exclusively breastfed for