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| Year : 2011
| Volume
: 13 | Issue : 52 | Page
: 229-233 |
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| Cardiovascular effects of environmental noise: Research in the United Kingdom |
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Stephen Stansfeld, Rosanna Crombie
Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, United Kingdom
Click here for correspondence address
and email
| Date of Web Publication | 29-Apr-2011 |
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Although the auditory effects of noise on humans have been established, the non-auditory effects are not so well established. The emerging links between noise and cardiovascular disease (CVD) have potentially important implications on public health and policy. In the United Kingdom (UK), noise from transport is a problem, where more than half of the population is exposed to more than the recommended maximum day-time noise level and just under three-quarters of the population live in areas where the recommended night-time noise level is exceeded. This review focuses on findings from studies conducted in the UK that examined environmental noise and cardiovascular disease. There were statistically no significant associations between road traffic noise and incident ischemic heart disease in the Caerphilly and Speedwell studies, but there was a suggestion of effects when modifying factors such as length of residence, room orientation, and window opening were taken into account. In a sample stratified by pre-existing disease a strongly increased odds of incident ischemic heart disease for the highest annoyance category was found compared to the lowest among men without pre-existing disease (OR = 2.45, 95%1.13 - 5.31), which was not found in men with pre-existing disease. In the Hypertension and exposure to noise near airports (HYENA) study, night time aircraft noise exposure (L night ) was associated with an increased risk of hypertension, in fully adjusted analyses. A 10-dB increase in aircraft noise exposure was associated with an odds ratio of 1.14 (95%CI, 1.01 - 1.29). Aircraft noise was not consistently related to raised systolic blood pressure in children in the road traffic and aircraft noise exposure and children's cognition and health (RANCH) study. There is some evidence of an association among environmental noise exposure and hypertension and ischemic heart disease in the UK studies; further studies are required to explore gender differences, the effects of day and night time exposure, and exposure modifying factors. Keywords: Aircraft noise, blood pressure, cardiovascular disease, hypertension, ischemic heart disease, road traffic noise
How to cite this article:
Stansfeld S, Crombie R. Cardiovascular effects of environmental noise: Research in the United Kingdom. Noise Health 2011;13:229-33 |
| Introduction | |  |
As in other European countries, environmental noise is a pervasive problem, especially road traffic noise, and although aircraft have generally become quieter there are more frequent flights. Daytime noise levels have generally decreased, but the quiet period during the night, without transport noise, has become shorter as demonstrated in a comparison of recent national noise surveys. [1]
On an average, daytime sound levels in the UK, in a 2000 - 2001 survey, were estimated as 57 dB L Aeq 16h , [1] and at the same time average night time sound levels (L Aeq 8h ) were 48 dB. The National Noise Incidence study found that about 55% of the UK population lived in dwellings exceeding the World Health Organization (WHO) recommended daytime sound level of 55 dB (L Aeq 16h ), [2] and that 67% lived in dwellings exceeding the night time recommendation of 45 dB (L Aeq 8h ); 8% of the UK population were exposed to sound levels exceeding 68 dB L A10 18h . [1] From the noise maps of London, derived in 2004, it was estimated that about 20% of the population of London were predicted to be exposed to traffic noise, outside their homes, at levels in excess of a daytime level of 60 dBA L Aeq 12h .
Cardiovascular disease, manifesting as hypertension, myocardial infarction, coronary heart disease (also known as ischemic heart disease), and cardiac mortality have been the most serious health outcomes linked to environmental noise exposure.
| Studies Investigating the Association Between Environmental Noise Exposure and Cardiovascular Disease | | |
A literature search was carried out in PubMed using noise and cardiovascular disease, coronary disease, and hypertension as search terms. From 2,717 papers, 11 abstracts reporting on UK data were identified as relevant. There have been two major epidemiological studies on adults set in the UK that have examined environmental noise exposure and the risk of cardiovascular disease. First, road traffic noise exposure was measured in the Caerphilly Collaborative Heart Disease study and related to ischemic (coronary heart) disease. [3] Second, the European HYENA study was led from London and included the study of health effects of exposure to aircraft and road traffic noise around Heathrow airport as well as five other European airports. [4]
Caerphilly and Speedwell study
At baseline (1979 - 1983) traffic noise exposure derived from noise maps was linked to prevalent ischemic heart disease and coronary risk factors in 2,512 men from the small Welsh town of Caerphilly. The noise exposure level in the whole sample varied from 51 - 70 dBA L Aeq . The traffic noise exposure was not statistically associated with the prevalence of myocardial infarction, stroke or high blood pressure. [5] However, the highest systolic blood pressures were recorded in the men who were most exposed to noise (146 mm Hg, 144 mm Hg). In a sample in which men with prevalent ischemic heart disease were excluded there were significant differences in systolic blood pressure between extreme groups of noise exposure. Neither diastolic blood pressure nor heart rate was related to the traffic noise level.
Traffic noise was associated with higher levels of estradiol, testosterone, cortisol, higher levels of total cholesterol, high density lipoprotein cholesterol, platelet count, fibrinogen, and antithrombin III. Interpretation of these findings should be cautious: although there was extensive adjustment for the confounding factors, the baseline study involved multiple comparisons and none of these indices showed convincing gradients by noise level. The traffic noise exposure was not associated with very low density lipoprotein and low density lipoprotein cholesterol, triglycerides, fibrin clotting time, thrombin time, white cell count, uric acid, total protein, glucose, hemoglobin, erythrocyte magnesium, alkaline phosphatase, or aspartate aminotransferase. [5]
In the sister study from Speedwell in Bristol, England, in 2,348 men, aged 45 - 63 years, blood pressure was not consistently associated with noise exposure and a different pattern of risk factors was associated with traffic noise exposure (51 - 70 dBA L Aeq 6-22hrs ): raised triglycerides, raised platelet count, increased plasma viscosity, increased glucose, and reduced fibrin clotting time. [6]
At the second phase of the study (1984 - 1988), prevalence and four-year incidence results were reported for pooled data, from the Caerphilly study and the sister Speedwell study (1982 - 1985) [7] [Table 1]. In men exposed to the highest noise category (L Aeq 6-22hrs = 66 - 70 dBA) the relative risk for prevalent myocardial infarction was approximately 10% higher, for electrocardiogram ischemia 30% higher, and for any ischemic heart disease (IHD) 20% higher than in those men exposed to the lowest noise category (51 - 55 dBA). The predicted incidence odds ratio (OR) for IHD, adjusted for covariates, in the sample of men who were disease-free at baseline and who had complete covariate and risk factor data (n = 3,196) relative to the lowest noise category was 1.2 (95% CI = 0.7 - 2.2) for 56 - 60 dBA; 1.1 (95% CI = 0.6 - 2.0) for 61 - 65 dBA; and 0.7 (95% CI=0.3 - 1.7) for 66 - 70 dBA. None of these associations were significant and they were not supportive of an exposure-effect association. The risk was diminished in the highest noise exposure category, although the predicted incident risk of ischemic heart disease (based on the risk factor profiles) in the highest noise category (66 - 70 dBA) adjusted for covariates was 1.1 (95% CI = 0.6 - 2.0). | Table 1: Epidemiological studies of environmental noise exposure and hypertension and coronary heart disease in adults in the UK
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The final study in the series on traffic noise and ischemic heart disease risk was reported on the ten-year incidence of ischemic heart disease from the pooled data of the Caerphilly and Speedwell samples. [8] The reconstructed pooled sample of those men who had completed a noise questionnaire included 3,997 men aged 47 - 67 years. In adjusted analyses in the complete sample at a 10-year follow-up the odds ratios for ischemic heart disease in the highest noise exposure group (66 - 70 dBA) relative to the lowest exposure group (51 - 55 dBA) was 1.07 (95% CI = 0.60 - 1.91) in the Caerphilly sample and 0.92 (95% CI = 0.1 - 1.41) in the Speedwell sample. Analyses were also carried out with respect to the follow-up period from phase 2 to phase 3 because additional information regarding room orientation, window opening habits, noise sensitivity, and noise annoyance were only assessed during phase 2. In the pooled data the odds ratio for ischemic heart disease at the six-year follow-up, that is, between phases 2 and 3 was 1.07, after full adjustment for the potentially confounding factors [Table 1]. However, for those men who had lived 15 years or more in the same residence (thus, in general, exposed to the same noise level) the odds ratio rose to 1.20 (95% CI = 0.72 - 2.03) in the extreme group comparison. Furthermore, taking into account the room orientation of living rooms and bedrooms, relative to the noise exposed façade, and window opening habits, the adjusted odds ratio for ischemic heart disease in the pooled sample was 1.30 (95% CI = 0.73 - 2.32) and increased to 1.59 (95% CI = 0.85 - 2.97) in those who had lived in the same residence for 15 years or more. [8] There was no increased risk of ischemic heart disease in the intermediate noise level categories. U-shaped associations between road traffic noise level and the incidence of ischemic heart diseases were found. The response rates were high and disease misclassification low in these studies. More confounding factors were adjusted for in these studies than in the previous studies, but there could have been exposure misclassification, because outdoor noise exposure might not adequately reflect an individual's true noise exposure level, as indoor exposure levels were excluded. Overall, although a statistically significant association was not demonstrated for road traffic noise exposure and ischemic heart disease, the studies could have been underpowered to demonstrate small effects and the evidence was suggestive of effects, taking into account more precise noise exposure and duration of exposure, indicated by the length of residence and room orientation.
More recent analyses have focussed on the potential mediating or moderating factors of the association between traffic noise and ischemic heart disease. [9] When the results were stratified according to the presence of a pre-existing disease (including prevalent ischemic heart disease and a range of chronic diseases), a higher risk of IHD incidence was found in men with prevalent chronic diseases in the highest noise category compared to the lowest (OR = 1.82, 95% CI = 0.92 - 3.58). In men without prevalent chronic diseases, however, a lower risk was found (OR = 0.84, 95% CI = 0.36 - 1.99). Although this tendency of an effect modification was statistically not significant, the result suggested that pre-existing illness was a vulnerability factor for the effects of noise on ischemic heart disease, when the objective noise level was considered for exposure. In this situation men with existing disease might have less capacity to adapt physiologically to noise, and thus might have a higher risk of developing ischemic heart disease.
Independent of the relationship between noise exposure and ischemic heart disease, the authors also found a suggestion of an effect modification by pre-existing disease, in the association of noise annoyance and ischemic heart disease. When stratified by the presence of a pre-existing disease a strongly increased odds of incident ischemic heart disease was found for the highest annoyance categories ('often or always' annoyed) compared to the lowest ('never or seldom' annoyed) among men without pre-existing (OR = 2.45, 95% 1.13 - 5.31) disease, but not in men with pre-existing disease (OR = 0.95, 95% CI = 0.52 - 1.75). This effect modification by a pre-existing disease was also found for most of the other disturbance variables. Response bias could be an explanation of the latter effect of a pre-existing disease in which men with chronic illness were more likely to report higher annoyance levels, irrespective of noise exposure. This might mean that annoyance responses in men with pre-existing disease were not reliable indicators of responses to road traffic.
HYENA study
This study involved measurement of blood pressure, socioeconomic, health, and lifestyle data in relation to aircraft and road traffic noise in 4,861 persons, aged between 45 and 70 years, who had lived for at least five years near six major European airports. [3] Unlike the Caerphilly study this included 2,457 women as well as 2,404 men. In analyses adjusting for country, age, body mass index (BMI), alcohol intake, education, and exercise, aircraft noise exposure during the night (L night ) was associated with an increased risk of hypertension. A 10 dB increase in aircraft noise exposure was associated with an odds ratio of 1.14 (95% CI, 1.01 - 1.29) [Table 1]. [10] Aircraft noise exposure during the daytime measured by L Aeq 16h was not associated with increased risk of hypertension. Road traffic noise exposure measured by L Aeq 24h was associated with a small significant increased risk of hypertension (OR = 1.097, 95% CI = 1.003 - 1.201). [10] There were no differences between men and women for aircraft noise at night and risk of hypertension, but the association with road traffic noise exposure was only found in men and there was a statistically significant difference in the trend shown between the sexes (P = 0.004). No heterogeneity of the aircraft noise results was demonstrated in the country-specific analyses. For road traffic noise there was significant heterogeneity between countries, but the estimated odds ratios using pooled analyses (adjusted for country) were similar to the computed estimate in the meta-analysis. In a sub-sample of 546 women and 530 men, greater than 65 years of age who might be more likely to spend most of their time at home, an excess risk of hypertension in women was found for a 10 dB increase in road traffic noise (OR = 1.63, 95% CI = 1.21 - 2.20). This was not seen in men and neither were there any differences in response to aircraft noise for either sex.
Ambulatory blood pressure at night was measured in a sub-sample of 140 subjects living near four major European airports with night flights, namely Athens, Malpensa, Arlanda, and London Heathrow. [11] An increase in blood pressure and heart rate was observed over the 15 minutes during which an aircraft event occurred, but this was not statistically significant for heart rate. A similar increase in blood pressure was observed during time periods with traffic or indoor noise events. The magnitude of the elevation was 6.2 mm Hg for systolic blood pressure and 7.4 mm Hg for diastolic blood pressure. When the maximum noise level of an event was assessed there were no systematic differences in the effect on blood pressure, whether the noise source was by an aircraft, road traffic, or an internal noise source. [11]
RANCH study
The studies discussed thus far have studied samples of adults. The road traffic and aircraft noise exposure and children's cognition and health (RANCH) study examined links between aircraft and road traffic noise exposure and blood pressure in children. In the RANCH study, aircraft and road traffic noise exposure around Schiphol and Heathrow airports were linked to blood pressure in 853 children, aged between 9 and 10 years, from 62 schools. [12] Aircraft noise exposure at school and at home was based on contour information. Road traffic noise exposure was based on noise modeling in The Netherlands and on the Calculation of Road Traffic Noise (CRTN) method in the UK. [13] In the initial pooled analysis, aircraft noise at school and at home was related to raised systolic blood pressure. Chronic aircraft noise exposure at home was also associated with raised systolic and diastolic blood pressure. In The Netherlands, chronic aircraft noise exposure during the night (L Aeq 23-7hrs ) was also associated with raised systolic blood pressure. After adjustment for age, sex, ponderosity, school glazing, country, socioeconomic status, ethnicity, cuff size, room temperature, parental high blood pressure, prematurity, double glazing at home, and other noise exposure, only the effects of aircraft noise at home remained significant. In the Dutch sample, school noise exposure predicted a systolic blood pressure increase of 0.17 mm Hg per dBA (95% CI = 0.01 - 0.33) and diastolic blood pressure of 0.20 mm Hg per dBA (95% CI = 0.06 - 0.34). These associations were not significant in the UK. In the pooled data, road traffic noise exposure at school was related to a significant decrease in systolic blood pressure - 0.11 mm Hg per dBA (95% CI = - 0.21 - 0.00), also found in both countries, separately. Overall, there was little consistency in the results, making it difficult to be certain of an effect of environmental noise on children's blood pressure.
| Public Health Issues | | |
The recent HYENA study results suggest that aircraft noise and road traffic noise are related to hypertension. The Caerphilly study results on hypertension are somewhat tentative, but suggestive of a positive relationship between road traffic noise exposure and hypertension, once exposure misclassification is reduced by considering the duration of exposure, window opening, and room orientation in relation to noise exposure. Moreover, they do suggest that people with an existing disease might be more vulnerable to noise effects and that higher annoyance responses in the absence of any disease may be a risk factor for hypertension. Nevertheless, because of the size of the sample, and the relatively low levels of road traffic noise in a small rural town, the effects of noise on blood pressure in the general population may be underestimated by these studies.
It is interesting that night time noise exposure is related to hypertension in the HYENA study. This may be increasingly significant with respect to public health, because the length of the night that is free of noise exposure is diminishing, and the growth in the 24-hour economy may increase the levels of noise at night, when people are sleeping. The RANCH study results in children are very mixed, although other studies of noise and children's blood pressure do suggest small positive effects. There is still a need for much further research, including longitudinal studies, in this area.
| Conclusions | | |
There has been a lot of recent research activity in the area of environmental noise and hypertension. In general the results of the HYENA study suggest that both aircraft noise and road traffic noise may be implicated in increased blood pressure. Nevertheless, inconsistencies in the results still remain and there are many difficulties in accurately measuring noise exposure. There is a need for better, future prospective studies, to take this research forward, to gain a greater understanding of the underlying mechanisms.
| Acknowledgments | | |
Rosanna Crombie is supported by the EU Seventh Framework Grant: European Network on Noise and Health (ENNAH) Grant No 226442.
| References | | |
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Correspondence Address:
Stephen Stansfeld
Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ
United Kingdom
 Source of Support: EU Seventh Framework Grant: European Network on Noise and Health (ENNAH) Grant No 226442, Conflict of Interest: None  | Check |
DOI: 10.4103/1463-1741.80159
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