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|Year : 2002 | Volume
| Issue : 16 | Page : 33--37
Prevalence of arterial hypertension and myocardial infarction in relation to subjective ratings of traffic noise exposure
Goran Belojevic1, Mica Saric-Tanaskovic2,
1 University of Belgrade, School of Medicine, Institute of Hygiene and Medical Ecology, Belgrade, Serbia
2 Institute for Public Health, Pancevo, Serbia
Institute of Hygiene and Medical Ecology, School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
A cross-sectional study was performed on a 5% sample of the adult population of the city of Pancevo (3622 residents). The response rate was 79 % (2874), with 1243 interviewed males (43%) and 1631 females (57%). Noise annoyance was assessed on a five- grade verbal scale (Not at all; Slightly; Moderately; Very; Extremely). Arterial hypertension was defined by antihypertensive treatment, information on which was obtained from questionnaire. Myocardial infarction was also subjectively confirmed. Prevalence and odds ratios of arterial hypertension and myocardial infarction were computed for subjects who were very much and extremely annoyed by noise, or moderately annoyed, using residents who were slightly annoyed or not annoyed at all as a referent category. Significant odds ratios (adjusted for age, body mass index and smoking habits) were found for self-reported arterial hypertension [1,8 (1,0-2,4 - 95% confidence interval) , P < 0,01] and myocardial infarction [1,7 (1,0 - 2,9), P < 0,05] in very much or extremely noise disturbed male subjects, compared to those who were not annoyed at all, or were slightly annoyed by noise. The respective odds ratios for females were lower and not statistically significant 1,1 (0,8-1,7) and 1 (0,4 - 2,0).
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Belojevic G, Saric-Tanaskovic M. Prevalence of arterial hypertension and myocardial infarction in relation to subjective ratings of traffic noise exposure.Noise Health 2002;4:33-37
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Belojevic G, Saric-Tanaskovic M. Prevalence of arterial hypertension and myocardial infarction in relation to subjective ratings of traffic noise exposure. Noise Health [serial online] 2002 [cited 2022 Jun 28 ];4:33-37
Available from: https://www.noiseandhealth.org/text.asp?2002/4/16/33/31830
Road traffic noise in urban environments is one of the major public health problems of modern times. Beside annoyance, sleep disturbances and decreased school performance, the evidences have been reported that living in noisy area may be the risk for onset of cardiovascular diseases, predominantly arterial hypertension and ischaemic heart disease (Stansfeld et al. 2000). In a comprehensive review of recent 19 epidemiological traffic noise studies from 14 locations, Babisch (1998) concluded that if outdoor noise levels were used as an exposure indicator, no consistent relationship between traffic noise level and the prevalence of hypertension could be proved. However, the results looked somewhat more consistent when noise annoyance was considered for exposure instead of noise level. The relative risks found here range from 0.8 to 2.3. Concerning ischaemic heart disease, prospective studies suggested a significant increase in the risk at noise levels above 65-70 dB(A), the relative risk ranging from 1.1 to 1.5. The results appeared as consistent when subjective responses of disturbances and annoyance were considered as exposure.
The pathogenic concept that links noise with the well-known risk factors of cardiovascular diseases is based on a general stress model. Noise as a stressor stimulates hypothalamopituitary-adrenal axis, the medulla of the suprarenal gland, and the sympathetic nervous system. Consequently, there occurs an increase in the release of circulating "stress hormones": ACTH, cortisol, adrenaline and noradrenaline, which are of crucial importance in regulating arterial blood pressure and coronary circulation (Masche et al. 2000).
There is a sparse evidence in scientific literature on sex differences in cardiovascular effects of noise. Laboratory findings have been reported about greater increase of urinary noradrenaline, pulse rate fluctuations and vascular constriction in women than for men exposed to noise of 7085 dBA (Osada et al., 1972). However, in other experiments with 15 minute exposure to different types of noise of 75 dBA, men provided significantly more important heart rate responses to noise than women did, indicated by increase in heart rate and blood pressure, whatever the age (Parrot et al, 1992; Petiot JC et al. 1992). In the available literature we have not found epidemiological studies that reported sex differences in the cardiovascular risk of living in a noisy environment.
The aim of our study was to investigate the prevalence of arterial hypertension and myocardial infarction with regard to subjective ratings of traffic noise exposure and to look if there were sex differences in this relation.
Subjects and method
A cross-sectional interview study was performed among the residents of the city of Pancevo (adult population about 70.000). The investigated zone consisted of 25 streets in the residential area and the city centre. According to the systematic noise measurements which have been performed once a month in these streets since 1999, using the procedures recommended by ISO (ISO 1982), the daily outdoor average Leq in this zone is from 60-64 dBA (range from 53 - 70 dBA), while during night Leq is from 50 - 55 dBA on average (range from 41-64 dBA). A 5% population sample (3622 residents) was formed using a step method by asking all the residents on every third address to fill in the questionnaires themselves. The response rate was 79% (2874), with 1243 interviewed males (43%) and 1631 females (57%).
The questionnaire consisted of questions concerning age, sex, smoking habits, body mass, height, antihypertensive treatment and subjective confirmation of medically diagnosed myocardial infarction. A noise annoyance question with a five- grade verbal scale (Not at all; Slightly; Moderately; Very; Extremely) was used according to the recommendation of International Commission for Biological Effects of Noise (Fields at al., 1998). The subjects were classified in three groups according to answers on noise annoyance scale. The first group comprised the subjects who were slightly annoyed or not annoyed at all. In the second category there were the subjects with moderate annoyance and in the third one, the subjects with a high or extremely high annoyance. Body mass index was calculated as body weight in kilograms divided by height in meters squared (kg per m 2 )
We computed crude odds ratios and 95% confidence intervals for arterial hypertension and myocardial infarction, stratified for sex, using subjects with low noise annoyance subjective rating as a referent category. In addition , we used logistic regression analysis for estimation of odds ratios adjusted for covariates: age (20-39, 40-59, ==> 60 years), smoking habits (0, 1-19 per day, or > 19 per day) and body mass index (30,0 kg/m 2 ).
A significant risk for arterial hypertension was observed in men with high noise annoyance, compared to subjects with low noise annoyance [Table 1].
No significant relationship was found between noise annoyance subjective ratings and the prevalence of arterial hypertension in female residents [Table 2].
The risk for myocardial infarction was significantly higher in men with high noise annoyance ratings in relation to subjects with low annoyance ratings [Table 3].
No significant relationship was found between the prevalence of myocardial infarction and subjective noise annoyance ratings in women [Table 4].
We have chosen subjective ratings of traffic noise exposure instead of measurement data for several reasons. The systematic measurements were performed outdoors, on only one measuring site in each street, once a month and the representativeness of these data for all the residents living in a specific street was questionable. There are also numerous covariates which influence the reliability of noise levels obtained from outdoor measurements as an objective indicator of the residents' noise exposure: orientation of bedrooms and living rooms, floor, daily period spent at home, presence of double-glazed windows and daily period of keeping the windows towards the street open. We accepted the fact that subjective assessment of traffic noise exposure may induce recall bias due to over-reporting, but in this case we choose the method with less shortcomings. Concerning the health outcomes we think that self-reports about antihypertensive treatment and medically diagnosed myocardial infarction are reliable subjective indicators.
Subjective assessments of noise exposure and disease have been used in several prior studies on cardiovascular effects of traffic noise. Similarly to our study a significant relative risk of 1,3 for self reported prevalence of hypertension was found in high road traffic noise disturbed subjects in a cross-sectional study carried out in Berlin (Wiens, 1995). Another large cross-sectional, community based study of 20.216 residents was conducted in China (Harvard-Anhui-Study) to identify and characterize major environmental and occupational determinants of blood pressure in rural communities (Xu et al. 1997). Multiple linear regression analysis indicated that among a long list of other factors, self reported exposure to noise was related to both increased systolic and diastolic blood pressure. However, the crosssectional studies from Amsterdam (Knipschild et al. 1984) and Tyrol (Lercher, 1992) did not show an increased risk of hypertension in subjects more annoyed by traffic noise as compared to less annoyed. Some reservation in interpreting these results must be kept in mind, with regard to recall bias.
Similarly to our findings concerning the prevalence of myocardial infarction and noise exposure, in the prospective studies carried out in Berlin (Babisch et al. 1994) and in Caerphilly and Speedwell (Babisch et al. 1999) male subjects of the highest annoyance category considered were found to be under higher risk from ischaemic heart disease compared to subjects with low noise annoyance (odds ratios between 1,0 and 1,4). In the cross-sectional studies from Tyrol (Lercher, 1992) and of a random German population sample (Bellach et al. 1995), the calculated odds ratios for ishaemic heart disease were between 0,8 and 1,9 in subjects greatly annoyed by traffic noise in comparison with subjects who were not as annoyed. Angina pectoris in particular, was the health outcome for which the relative risks was greater than 1.
Our finding about of the greater cardiovascular risk for noise annoyed men than for women is supported by the experiments in which the cardiovascular response under noise was more pronounced in men (Parrot et al, 1992; Petiot JC et al. 1992).
In this cross sectional interview study we showed that highly noise disturbed adult male residents of the city of Pancevo were under increased risk of arterial hypertension and myocardial infarction, compared to subjects slightly annoyed, or not annoyed by noise. Among female residents this relation was not statistically significant
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