Road traffic noise, noise sensitivity, noise annoyance, psychological and physical health and mortality.

BACKGROUND: Both physical and psychological health outcomes have been associated with exposure to environmental noise. Noise sensitivity could have the same moderating effect on physical and psychological health outcomes related to environmental noise exposure as on annoyance but this has been little tested. METHODS: A cohort of 2398 men between 45 and 59 years, the longitudinal Caerphilly Collaborative Heart Disease study, was established in 1984/88 and followed into the mid-1990s. Road traffic noise maps were assessed at baseline. Psychological ill-health was measured in phase 2 in 1984/88, phase 3 (1989/93) and phase 4 (1993/7). Ischaemic heart disease was measured in clinic at baseline and through hospital records and records of deaths during follow up. We examined the longitudinal associations between road traffic noise and ischaemic heart disease morbidity and mortality using Cox Proportional Hazard Models and psychological ill-health using Logistic Regression; we also examined whether noise sensitivity and noise annoyance might moderate these associations. We also tested if noise sensitivity and noise annoyance were longitudinal predictors of ischaemic heart disease morbidity and mortality and psychological ill-health. RESULTS: Road traffic noise was not associated with ischaemic heart disease morbidity or mortality. Neither noise sensitivity nor noise annoyance moderated the effects of road traffic noise on ischaemic heart disease morbidity or mortality. High noise sensitivity was associated with lower ischaemic heart disease mortality risk (HR = 0.74, 95%CI 0.57, 0.97). Road traffic noise was associated with Phase 4 psychological ill-health but only among those exposed to 56-60dBA (fully adjusted OR = 1.82 95%CI 1.07, 3.07). Noise sensitivity moderated the association of road traffic noise exposure with psychological ill-health. High noise sensitivity was associated longitudinally with psychological ill-health at phase 3 (OR = 1.85 95%CI 1.23, 2.78) and phase 4 (OR = 1.65 95%CI 1.09, 2.50). Noise annoyance predicted psychological ill-health at phase 4 (OR = 2.47 95%CI 1.00, 6.13). CONCLUSIONS: Noise sensitivity is a specific predictor of psychological ill-health and may be part of a wider construct of environmental susceptibility. Noise sensitivity may increase the risk of psychological ill-health when exposed to road traffic noise. Noise annoyance may be a mediator of the effects of road traffic noise on psychological ill-health.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use: results of a pooled-analysis from seven European countries.

BACKGROUND: Few studies have considered aircraft noise annoyance and noise sensitivity in analyses of the health effects of aircraft noise, especially in relation to medication use. This study aims to investigate the moderating and mediating role of these two factors in the relationship between aircraft noise levels and medication use among 5860 residents of ten European airports included in the HYENA and DEBATS studies. METHODS: Information on aircraft noise annoyance, noise sensitivity, medication use, and demographic, socio-economic and lifestyle factors was collected during a face-to-face interview at home. Medication was coded according to the Anatomical Therapeutic Chemical (ATC) classification. Outdoor aircraft noise exposure was estimated by linking the participant's home address to noise contours using Geographical Information Systems (GIS) methods. Logistic regressions with adjustment for potential confounding factors were used. In addition, Baron and Kenny's recommendations were followed to investigate the moderating and mediating effects of aircraft noise annoyance and noise sensitivity. RESULTS: A significant association was found between aircraft noise levels at night and antihypertensive medication only in the UK (OR = 1.43, 95%CI 1.19-1.73 for a 10 dB(A)-increase in Lnight). No association was found with other medications. Aircraft noise annoyance was significantly associated with the use of antihypertensive medication (OR = 1.33, 95%CI 1.14-1.56), anxiolytics (OR = 1.48, 95%CI 1.08-2.05), hypnotics and sedatives (OR = 1.60, 95%CI 1.07-2.39), and antasthmatics (OR = 1.44, 95%CI 1.07-1.96), with no difference between countries. Noise sensitivity was significantly associated with almost all medications, with the exception of the use of antasthmatics, showing an increase in ORs with the level of noise sensitivity, with differences in ORs among countries only for the use of antihypertensive medication. The results also suggested a mediating role of aircraft noise annoyance and a modifying role of both aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use. CONCLUSIONS: The present study is consistent with the results of the small number of studies available to date suggesting that both aircraft noise annoyance and noise sensitivity should be taken into account in analyses of the health effects of exposure to aircraft noise.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and hypertension risk: Results of a pooled analysis from seven European countries.

INTRODUCTION: Many studies, including the HYENA and the DEBATS studies, showed a significant association between aircraft noise exposure and the risk of hypertension. Few studies have considered aircraft noise annoyance and noise sensitivity as factors of interest, especially in relation to hypertension risk, or as mediating or modifying factors. The present study aims 1) to investigate the risk of hypertension in relation to aircraft noise annoyance or noise sensitivity; and 2) to examine the role of modifier or mediator of these two factors in the association between aircraft noise levels and the risk of hypertension. METHODS: This study included 6,105 residents of ten European airports from the HYENA and DEBATS studies. Information on aircraft noise annoyance, noise sensitivity, and demographic, socioeconomic and lifestyle factors was collected during an interview performed at home. Participants were classified as hypertensive if they had either blood pressure levels above the WHO cut-off points or physician-diagnosed hypertension in conjunction with the use of antihypertensive medication. Outdoor aircraft noise exposure was estimated for each participant's home address. Poisson regression models with adjustment for potential confounders were used. Interactions between noise exposure and country were tested to consider possible differences between countries. RESULTS: An increase in aircraft noise levels at night was weekly but significantly associated with an increased risk of hypertension (RR = 1.03, 95% CI 1.01-1.06 for a 10-dB(A) increase in Lnight). A significant association was found between aircraft noise annoyance and hypertension risk (RR = 1.06, 95%CI 1.00-1.13 for highly annoyed people compared to those who were not highly annoyed). The risk of hypertension was slightly higher for people highly sensitive to noise compared to people with low sensitivity in the UK (RR = 1.29, 95%CI 1.05-1.59) and in France (RR = 1.11, 95%CI 0.68-1.82), but not in the other countries. The association between aircraft noise levels and the risk of hypertension was higher among highly sensitive participants (RR = 1.00, 95%CI 0.96-1.04; RR = 1.03, 95%CI 0.90-1.11; RR = 1.12, 95%CI 1.01-1.24, with a 10-dB(A) increase in Lnight for low, medium, and high sensitive people respectively) or, to a lesser extent, among highly annoyed participants (RR = 1.06, 95%CI 0.95-1.18 for a 10-dB(A) increase in Lnight among highly annoyed participants, and RR = 1.02, 95%CI 0.99-1.06 among those not highly annoyed). CONCLUSIONS: The present study confirms findings in the small number of available studies to date suggesting adverse health effects associated with aircraft noise annoyance and noise sensitivity. The findings also indicate possible modifier effects of aircraft noise annoyance and noise sensitivity in the relationship between aircraft noise levels and the risk of hypertension. However, further investigations are needed to better understand this role using specific methodology and tools related to mediation analysis and causal inference.

Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries.

BACKGROUND: Many studies have demonstrated adverse effects of exposure to aircraft noise on health. Possible biological pathways for these effects include hormonal disturbances. Few studies deal with aircraft noise effects on saliva cortisol in adults, and results are inconsistent. OBJECTIVE: We aimed to assess the effects of aircraft noise exposure on saliva cortisol levels and its variation in people living near airports. METHODS: This study focused on the 1300 residents included in the HYENA and DEBATS cross-sectional studies, with complete information on cortisol sampling. All the participants followed a similar procedure aiming to collect both a morning and an evening saliva cortisol samples. Socioeconomic and lifestyle information were obtained during a face-to-face interview. Outdoor aircraft noise exposure was estimated for each participant's home address. Associations between aircraft noise exposure and cortisol outcomes were investigated a priori for male and female separately, using linear regression models adjusted for relevant confounders. Different approaches were used to characterize cortisol levels, such as morning and evening cortisol concentrations and the absolute and relative variations between morning and evening levels. RESULTS: Statistically significant increases of evening cortisol levels were shown in women with a 10-dB(A) increase in aircraft noise exposure in terms of LAeq, 16h (exp(ß) = 1.08; CI95% = 1.00-1.16), Lden (exp(ß) = 1.09; CI95% = 1.01-1.18), Lnight (exp(ß) = 1.11; CI95% = 1.02-1.20). A statistically significant association was also found in women between a 10-dB(A) increase in terms of Lnight and the absolute variation per hour (exp(ß) = 0.90; CI95% = 0.80-1.00). Statistically significant decreases in relative variation per hour were also evidenced in women, with stronger effects with the Lnight (exp(ß) = 0.89; CI95% = 0.83-0.96) than with other noise indicators. The morning cortisol levels were unchanged whatever noise exposure indicator considered. There was no statistically significant association between aircraft noise exposure and cortisol outcomes in men. CONCLUSIONS: The results of the present study show statistically significant associations between aircraft noise exposure and evening cortisol levels and related flattening in the (absolute and relative) variations per hour in women. Further biological research is needed to deepen knowledge of the pathway between noise exposure and disturbed hormonal regulation, and specially the difference in effects between genders.

Long-term associations of modeled and self-reported measures of exposure to air pollution and noise at residence on prevalent hypertension and blood pressure.

Air pollution, traffic noise and noise annoyance are suggested to be associated with hypertension and blood pressure (BP); however, the evidence remains inconsistent. Our study examined the long-term associations of modeled and self-reported measures of air pollution and traffic noise on prevalent hypertension and BP. We analyzed cross-sectional data from 2552 participants aged 31-72years from the KORA F4 (2006-2008) study conducted in the region of Augsburg, Germany. Land-use regression models were used to estimate residential long-term exposure to particulate matter <2.5µm (PM2.5), soot content of PM2.5 (PM2.5abs) and nitrogen dioxide (NO2). Road traffic noise levels at the facade of the dwellings were estimated for the participants' residences. Participants filled-in a questionnaire on noise annoyance and heavy traffic passing their residence. Linear and logistic regression models adjusting for confounders were used to assess the association between exposure measures and hypertension and BP. An interquartile increase in annual mean PM2.5 (1µg/m3) was significantly associated with 15% higher prevalence of hypertension, without (95% CI: 2.5; 28.0%) and with (95% CI: 0.7; 30.8%) adjustment for traffic noise. Diastolic blood pressure (DBP) was associated with air pollutants and traffic noise with percent increases in mean of 0.7 (95% CI: 0.2; 1.2), 0.6 (95% CI: 0.1; 1.1) and 0.3 (95% CI: 0.0; 0.7) for an interquartile increase in PM2.5 (1µg/m3) and PM2.5abs (0.2∗10-5/m), and 5dB(A) increase in 24-hour road traffic noise, respectively. Associations of PM2.5abs and NO2 with hypertension or DBP were stronger in men and diabetic individuals. No clear associations were seen with systolic BP or noise annoyance. In conclusion, self-reported measures of air pollution or noise did not perform better than the objective measures. Our findings provide further evidence for a link between air pollution, noise and cardiovascular disease and indicate a stronger association for men and diabetic individuals.

Road traffic noise and hypertension--accounting for the location of rooms.

OBJECTIVE: The association between the exposure to road traffic noise and the prevalence of hypertension was assessed accounting for background air pollution and the location of rooms with respect to the road. METHODS: A cross-sectional study was carried out inviting all subjects aged 35-74 years for participation that lived on 7 major trunk roads in 3-4 storey terraced apartment buildings and in parallel side streets that were completely shielded from noise due to the rows of houses along the major roads. The study was performed on 1770 subjects that did not have a self-reported medical doctor diagnosis of hypertension before they moved into their current residence. Noise levels at the facade of the front and the rear side of the houses were drawn from available noise maps of the area. A large set of covariates were considered to adjust the results for confounding. RESULTS: Significant increases between road traffic noise and hypertension were found with respect to the 24h A-weighted average noise indicator L(DEN). The adjusted odds ratio (OR) per noise level increment of 10 dB(A) was 1.11 (95% confidence interval (CI): 1.00-1.23). Stronger significant estimates of the noise effect were found in subjects with long residence time (OR=1.20, CI=1.05-1.37), and with respect to the exposure of the living room during daytime (OR=1.24, CI=1.08-1.41) compared with the exposure of the bedroom during night-time (OR=0.91, CI=0.78-1.06). CONCLUSION: Chronic exposure to road traffic noise is associated with an increased risk of high blood pressure. Daytime noise exposure of the living room had a stronger impact on the association than night-time exposure of the bedroom.

Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults: the KORA study.

BACKGROUND: Studies on the association between traffic noise and cardiovascular diseases have rarely considered air pollution as a covariate in the analyses. Isolated systolic hypertension has not yet been in the focus of epidemiological noise research. METHODS: The association between traffic noise (road and rail) and the prevalence of hypertension was assessed in two study populations with a total of 4,166 participants 25-74 years of age. Traffic noise (weighted day-night average noise level; LDN) at the facade of the dwellings was derived from noise maps. Annual average PM2.5 mass concentrations at residential addresses were estimated by land-use regression. Hypertension was assessed by blood pressure readings, self-reported doctor-diagnosed hypertension, and antihypertensive drug intake. RESULTS: In the Greater Augsburg, Germany, study population, traffic noise and air pollution were not associated with hypertension. In the City of Augsburg population (n = 1,893), where the exposure assessment was more detailed, the adjusted odds ratio (OR) for a 10-dB(A) increase in noise was 1.16 (95% CI: 1.00, 1.35), and 1.11 (95% CI: 0.94, 1.30) after additional adjustment for PM2.5. The adjusted OR for a 1-µg/m3 increase in PM2.5 was 1.15 (95% CI: 1.02, 1.30), and 1.11 (95% CI: 0.98, 1.27) after additional adjustment for noise. For isolated systolic hypertension, the fully adjusted OR for noise was 1.43 (95% CI: 1.10, 1.86) and for PM2.5 was 1.08 (95% CI: 0.87, 1.34). CONCLUSIONS: Traffic noise and PM2.5 were both associated with a higher prevalence of hypertension. Mutually adjusted associations with hypertension were positive but no longer statistically significant.

Updated exposure-response relationship between road traffic noise and coronary heart diseases: a meta-analysis.

A meta-analysis of 14 studies (17 individual effect estimates) on the association between road traffic noise and coronary heart diseases was carried out. A significant pooled estimate of the relative risk of 1.08 (95% confidence interval: 1.04, 1.13) per increase of the weighted day-night noise level L DN of 10 dB (A) was found within the range of approximately 52-77 dB (A) (5 dB-category midpoints). The results gave no statistically significant indication of heterogeneity between the results of individual studies. However, stratified analyses showed that the treatment of gender in the studies, the lowest age of study subjects and the lowest cut-off of noise levels had an impact on the effect estimates of different studies. The result of the meta-analysis complies quantitatively with the result of a recent meta-analysis on the association between road traffic noise and hypertension. Road traffic noise is a significant risk factor for cardiovascular diseases.

Cardiovascular effects of environmental noise exposure.

The role of noise as an environmental pollutant and its impact on health are being increasingly recognized. Beyond its effects on the auditory system, noise causes annoyance and disturbs sleep, and it impairs cognitive performance. Furthermore, evidence from epidemiologic studies demonstrates that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, and stroke. Both observational and experimental studies indicate that in particular night-time noise can cause disruptions of sleep structure, vegetative arousals (e.g. increases of blood pressure and heart rate) and increases in stress hormone levels and oxidative stress, which in turn may result in endothelial dysfunction and arterial hypertension. This review focuses on the cardiovascular consequences of environmental noise exposure and stresses the importance of noise mitigation strategies for public health.

Auditory and non-auditory effects of noise on health.

Noise is pervasive in everyday life and can cause both auditory and non-auditory health effects. Noise-induced hearing loss remains highly prevalent in occupational settings, and is increasingly caused by social noise exposure (eg, through personal music players). Our understanding of molecular mechanisms involved in noise-induced hair-cell and nerve damage has substantially increased, and preventive and therapeutic drugs will probably become available within 10 years. Evidence of the non-auditory effects of environmental noise exposure on public health is growing. Observational and experimental studies have shown that noise exposure leads to annoyance, disturbs sleep and causes daytime sleepiness, affects patient outcomes and staff performance in hospitals, increases the occurrence of hypertension and cardiovascular disease, and impairs cognitive performance in schoolchildren. In this Review, we stress the importance of adequate noise prevention and mitigation strategies for public health.

The associations between traffic-related air pollution and noise with blood pressure in children: results from the GINIplus and LISAplus studies.

Although traffic emits both air pollution and noise, studies jointly examining the effects of both of these exposures on blood pressure (BP) in children are scarce. We investigated associations between land-use regression modeled long-term traffic-related air pollution and BP in 2368 children aged 10 years from Germany (1454 from Munich and 914 from Wesel). We also studied this association with adjustment of long-term noise exposure (defined as day-evening-night noise indicator "Lden" and night noise indicator "Lnight") in a subgroup of 605 children from Munich inner city. In the overall analysis including 2368 children, NO2, PM2.5 mass (particles with aerodynamic diameters below 2.5µm), PM10 mass (particles with aerodynamic diameters below 10µm) and PM2.5 absorbance were not associated with BP. When restricting the analysis to the subgroup of children with noise information (N=605), a significant association between NO2 and diastolic BP was observed (-0.88 (95% confidence interval: -1.67, -0.08)). However, upon adjusting the models for noise exposure, only noise remained independently and significantly positively associated with diastolic BP. Diastolic BP increased by 0.50 (-0.03, 1.02), 0.59 (0.05, 1.13), 0.55 (0.03, 1.07), and 0.58 (0.05, 1.11)mmHg for every five decibel increase in Lden and by 0.59 (-0.05, 1.22), 0.69 (0.04, 1.33), 0.64 (0.02, 1.27), and 0.68 (0.05, 1.32)mmHg for every five decibel increase in Lnight, in different models of NO2, PM2.5 mass, PM10 mass and PM2.5 absorbance as the main exposure, respectively. In conclusion, air pollution was not consistently associated with BP with adjustment for noise, noise was independently and positively associated with BP in children.

Exposure to aircraft and road traffic noise and associations with heart disease and stroke in six European countries: a cross-sectional study.

BACKGROUND: Although a number of studies have found an association between aircraft noise and hypertension, there is a lack of evidence on associations with other cardiovascular disease. For road traffic noise, more studies are available but the extent of possible confounding by air pollution has not been established. METHODS: This study used data from the Hypertension and Environmental Noise near Airports (HYENA) study. Cross-sectional associations between self-reported 'heart disease and stroke' and aircraft noise and road traffic noise were examined using data collected between 2004 and 2006 on 4712 participants (276 cases), who lived near airports in six European countries (UK, Germany, Netherlands, Sweden, Greece, Italy). Data were available to assess potential confounding by NO2 air pollution in a subsample of three countries (UK, Netherlands, Sweden). RESULTS: An association between night-time average aircraft noise and 'heart disease and stroke' was found after adjustment for socio-demographic confounders for participants who had lived in the same place for ≥ 20 years (odds ratio (OR): 1.25 (95% confidence interval (CI) 1.03, 1.51) per 10 dB (A)); this association was robust to adjustment for exposure to air pollution in the subsample. 24 hour average road traffic noise exposure was associated with 'heart disease and stroke' (OR: 1.19 (95% CI 1.00, 1.41), but adjustment for air pollution in the subsample suggested this may have been due to confounding by air pollution. Statistical assessment (correlations and variance inflation factor) suggested only modest collinearity between noise and NO2 exposures. CONCLUSIONS: Exposure to aircraft noise over many years may increase risks of heart disease and stroke, although more studies are needed to establish how much the risks associated with road traffic noise may be explained by air pollution.

The association between road traffic noise exposure and blood pressure among children in Germany: the GINIplus and LISAplus studies.

Studies examining the association between road traffic noise and blood pressure in children are scarce. Nighttime noise levels and window orientations have not been considered in most previous studies. Investigate the association between road traffic noise exposure and blood pressure among children, and investigate the impact of bedroom window direction on this association. We measured blood pressure in 605 children aged 10 years from two Munich cohorts. Demographic and health information was collected by parent completed questionnaires. Road traffic noise levels were assessed by day-evening-night noise indicator "Lden" and night noise indicator "Lnight". Minimum and maximum levels within a 50 m buffer around child's home address were derived. Generalized additive models were applied to explore effect of noise levels on systolic and diastolic blood pressure (SBP and DBP). The orientation of child's bedroom window was considered in sensitivity analyses. DBP was significantly associated with the minimum level of noise during 24 h (Lden_min) and nightime (Lnight_min). Specifically, DBP increased by 0.67 and 0.89 mmHg for every 5 A-weighted decibels increase in Lden_min and Lnight_min. After adjusting for Lden_min (Lnight_min), DBP of children whose bedroom window faced the street was 1.37 (1.28) mmHg higher than those whose bedroom window did not, these children showed statistically significant increased SBP for Lden_min (3.05 mmHg) and Lnight_min (3.27 mmHg) compared to children whose bedroom window did not face the street. Higher minimum levels of weighted day-evening-night noise and nighttime noise around the home residence may increase a child's blood pressure.

Exposure to road traffic noise and children's behavioural problems and sleep disturbance: results from the GINIplus and LISAplus studies.

BACKGROUND: Exposure to transportation noise showed negative health effects in children and adults. Studies in children mainly focussed on aircraft noise at school. OBJECTIVES: We aimed to investigate road traffic noise exposure at home and children's behavioural problems and sleeping problems. METHODS: 872 10-year-old children from Munich from two German population-based, birth-cohort studies with data on modelled façade noise levels at home and behavioural problems were included. Noise was assessed by the day-evening-night noise indicator Lden and the night noise indicator Lnight. Behavioural problems were assessed by the Strengths and Difficulties Questionnaire (SDQ). A subgroup (N=287) had information on sleeping problems. Continuation ratio models (logistic regression models) adjusted for various covariates were applied to investigate the association between interquartile range increases in noise and SDQ scales (sleeping problems). RESULTS: Noise measured by Lden at the most exposed façade of the building was related to more hyperactivity/inattention (continuation odds ratio (cOR)=1.28(95%-confidence interval(CI):1.03-1.58). Noise at the least exposed façade increased the relative odds for having borderline or abnormal values on the emotional symptoms scale, especially the relative odds to have abnormal values for a subject with at least borderline values (Lden:cOR=2.19(95% CI:1.32-3.64). Results for Lnight were similar. Nocturnal noise at the least exposed façade was associated with any sleeping problems (odds ratio (OR)=1.79(95% CI=1.10-2.92)). CONCLUSIONS: Road traffic noise exposure at home may be related to increased hyperactivity and more emotional symptoms in children. Future longitudinal studies are required to explore noise exposure and behavioural problems in more detail, especially the role of sleep disturbances.

Noise annoyance--a modifier of the association between noise level and cardiovascular health?

OBJECTIVES: The effect modifying impact of annoyance due to aircraft noise and road traffic noise on the relationships between the aircraft noise level and road traffic noise level on the prevalence of hypertension was investigated in 4861 subjects of the HYENA study (HYpertension and Exposure to Noise near Airports). METHODS: Different models were investigated either including the noise level and noise annoyance variables separately, or simultaneously, or together with an interaction term referring to the same noise source for the noise level and the noise annoyance. RESULTS: Significant effect modification was found with respect to the association between aircraft noise and hypertension. The association was stronger in more annoyed subjects. No clear interaction was found with respect to road traffic noise. The comparison of the magnitude of the main effects (per standard deviation or inter-quartile range) of noise level and noise annoyance variables revealed stronger associations with hypertension for the noise levels. CONCLUSION: There is some indication that the noise level has a stronger predictive meaning for the relationship between noise exposure and hypertension than the reported noise annoyance (main effects). The results from the Hyena study support the hypothesis that noise annoyance acts as an effect modifier of the relationship between the noise level and hypertension.

Exposure modifiers of the relationships of transportation noise with high blood pressure and noise annoyance.

In the cross-sectional hypertension and exposure to noise near airports study the relationship between road traffic noise, aircraft noise and hypertension and annoyance was investigated. The data collection comprised a variety of potentially exposure modifying factors, including type of housing, location of rooms, window opening habits, use of noise-reducing remedies, shielding due to obstacles, lengths of exposure. In the present paper the quantitative role of these factors on the relationship between road and aircraft noise exposure and outcomes was analyzed. Multiple logistic and linear regression models were calculated including these co-factors and related interaction terms with noise indicators, as well as stratified analyses. Type of housing, length of residence, location of rooms and the use of noise reducing remedies modified the relationship between noise and hypertension. However, the effects were not always in the direction of a stronger association in higher exposed subjects. Regarding annoyance, type of housing, location of rooms, noise barriers, window opening habits, noise insulation, the use of noise reducing remedies, hours spent at home during daytime were significant effect modifiers. The use of noise-reducing remedies turned out to be indicators of perceived noise disturbance rather than modifiers reducing the annoyance.

Auditory threshold, phonologic demand, and incident dementia.

OBJECTIVE: This study was undertaken to investigate the association of auditory threshold with cognitive decline and dementia. METHODS: The 1,057 surviving men of the Caerphilly cohort with audiometric data at baseline were followed for 17 years for cognitive outcomes. Pure-tone unaided audiometric threshold was assessed at 0.5, 1, 2, and 4 KHz at baseline and after 9 years. Incident dementia was assessed according to DSM-IV criteria, including standard criteria for vascular dementia and for Alzheimer disease. Cognitive decline was assessed by repeat administration of a cognitive test battery. RESULTS: Mean age-adjusted auditory threshold across both time points was associated with incident dementia and cognitive decline. After adjustment for premorbid cognitive function, the association with dementia was retained (odds ratio(0.5 KHz) = 2.67; 95% confidence interval, 1.38-5.18; p = 0.004). Stronger associations with cognitive decline were found for tests administered by interview than for those administered by computer. CONCLUSIONS: This study has found an association of auditory threshold with dementia and cognitive decline over a 17-year period. The mechanisms underlying this association are unclear and may include a prodromal effect of dementia on auditory threshold, an effect of auditory threshold on cognitive assessment, an effect of auditory threshold on cognitive loss, or a shared etiologic pathway between both.

The quantitative relationship between road traffic noise and hypertension: a meta-analysis.

OBJECTIVE: Reviews have suggested that road noise exposure is associated with high blood pressure (hypertension). No reliable exposure-response relationship is as yet available. A meta-analysis was carried out in order to derive a quantitative exposure-response relationship between the exposure to road traffic noise and the prevalence of hypertension, and to gain some insight into the sources of heterogeneity among study results. METHODS: Twenty-seven observational studies published between 1970 and 2010 in English, German or Dutch, were evaluated. Finally, the results of 24 studies were included into the data aggregation. RESULTS: Road traffic noise was positively and significantly associated with hypertension: Data aggregation revealed an odds ratio (OR) of 1.034 [95% confidence interval (CI) 1.011-1.056] per 5 dB(A) increase of the 16 h average road traffic noise level (LAeq16hr) [range 45-75 dB(A)]. Important sources of heterogeneity were the age and sex of the population under study, the way exposure was ascertained, and the noise reference level used. Also the way noise was treated in the statistical model and the minimum years of residence of the population under study, gave an explanation of the observed heterogeneity. No definite conclusions can be drawn about the threshold value for the relationship between road traffic noise and the prevalence of hypertension. CONCLUSION: Based on the meta-analysis, a quantitative relationship is derived that can be used for health impact assessment. The results of this meta-analysis are consistent with a slight increase of cardiovascular disease risk in populations exposed to transportation noise.

Overview of the study design, participation and field work of the German Environmental Survey on Children 2003-2006 (GerES IV).

The German Federal Environment Agency carried out its fourth German Environmental Survey (GerES IV), which is the first survey on children only and the environment-related module of the German Health Interview and Examination Survey for Children and Adolescents (German acronym: KiGGS), conducted by the Robert Koch Institute (RKI). The German Environmental Surveys are nationwide population studies conducted to determine the exposure to environmental pollutants, to explore exposure pathways and to identify sub-groups with higher exposure. GerES IV was conducted on randomly selected 1790 children aged 3-14 years from the cross-sectional sample of KiGGS. The participants of GerES IV lived in 150 sampling locations all over Germany. Field work was carried out from May 2003 to May 2006. The response rate in GerES IV was 77.3%. Due to the fact that participation in GerES IV was limited to children that had previously participated in the KiGGS study, the total response rate in GerES IV resulted in 52.6%. Response rates did neither differ significantly between West and East Germany, nor between different community sizes, age groups and gender. The basic study programme included blood samples, morning urine, tap water and house dust as well as comprehensive questionnaire-based interviews. In addition, subgroups were studied with regard to "noise, hearing capacity and stress hormones", "chemical contamination of indoor air" and "biogenic indoor contamination". A key element of the field work in GerES IV was a home visit to carry out interviews, conduct measurements and collect samples. An exception was blood sampling which was carried out within KiGGS. The quality of field work, data collection, evaluation, and chemical, biological and physical analyses was successfully evaluated by internal and external quality assurance. This comprehensive overview aims at giving other research groups the opportunity to compare different study designs or to adapt their own design to get comparable results.

Road traffic noise: self-reported noise annoyance versus GIS modelled road traffic noise exposure.

BACKGROUND AND OBJECTIVES: self-reported road traffic noise annoyance is commonly used in epidemiological studies for assessment of potential health effects. Alternatively, some studies have used geographic information system (GIS) modelled exposure to road traffic noise as an objective parameter. The aim of this study was to analyse the association between noise exposure due to neighbouring road traffic and the noise annoyance of adults, taking other determinants into consideration. METHODS: parents of 951 Munich children from the two German birth cohorts GINIplus and LISAplus reported their annoyance due to road traffic noise at home. GIS modelled road traffic noise exposure (L(den), maximum within a 50 m buffer) from the noise map of the city of Munich was available for all families. GIS-based calculated distance to the closest major road (≥10,000 vehicles per day) and questionnaire based-information about family income, parental education and the type of the street of residence were explored for their potential influence. An ordered logit regression model was applied. The noise levels (L(den)) and the reported noise annoyance were compared with an established exposure-response function. RESULTS: the correlation between noise annoyance and noise exposure (L(den)) was fair (Spearman correlation r(s) = 0.37). The distance to a major road and the type of street were strong predictors for the noise annoyance. The annoyance modelled by the established exposure-response function and that estimated by the ordered logit model were moderately associated (Pearson's correlation r(p) = 0.50). CONCLUSIONS: road traffic noise annoyance was associated with GIS modelled neighbouring road traffic noise exposure (L(den)). The distance to a major road and the type of street were additional explanatory factors of the noise annoyance appraisal.